小剂量垂体后叶素对脓毒性休克患者心肺损伤指标及组织灌注和氧代谢指标的影响  

Effect of low dose pituitrin on biomarkers of cardiopulmonary injury, tissue perfusion and oxygen metabolism in patients with septic shock

作　　者：朱红阳[1] 徐晓[1] 倪红英[1] 章仲恒[1] 邓鸿胜 朱莉[1] 

机构地区：[1]浙江省金华市中心医院重症医学科,浙江金华321000

出　　处：《中国中西医结合急救杂志》2014年第5期376-381,共6页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省金华市科技计划资助项目（2010-3-024）

摘　　要：目的：探讨小剂量垂体后叶素（Pt）对脓毒性休克患者心肺损伤指标和组织灌注、氧代谢指标及预后的影响。方法采用前瞻性随机对照研究方法，将76例去甲肾上腺素（NE）用量≥0.2μg · kg-1· min-1的脓毒性休克患者按随机数字表法分为两组。两组患者均按“成人脓毒性休克的血流动力学监测和支持指南”给予早期监测及集束化治疗，标准治疗组单用NE，研究组给予NE合用Pt（0.7~2.3 U/h），在维持目标血压〔平均动脉压（MAP）65～90 mmHg（1 mmHg＝0.133 kPa）〕的前提下逐渐减少NE或Pt用量，MAP＜65 mmHg则给予补液和（或）增加NE的用量，MAP≥70 mmHg持续稳定12 h以上则停用氢化可的松（HC）。检测两组患者入组前和入组6、24、48、96 h MAP、心率（HR）、使用HC例次、NE用量、感染相关器官衰竭评分（SOFA评分）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、氧合指数（OI）、呼气末正压（PEEP）、血浆N末端B型脑钠肽前体（NT-proBNP）、心肌肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK-MB）、中心静脉血氧饱和度（ScvO2）、血乳酸（Lac）、血肌酐（SCr）的变化，并观察两组NE应用时间、24 h补液量、机械通气时间、ICU住院时间、28 d病死率及不良反应发生情况。结果76例患者纳入本研究，两组基线指标比较差异均无统计学意义（均P＞0.05）；与入组前比较，两组入组后MAP、OI、ScvO2均升高，HR、SOFA评分、APACHEⅡ评分、PEEP、Lac、SCr均降低，于入组96 h达峰值或谷值，且以研究组的变化更显著〔MAP（mmHg）：78.5±10.3比72.3±14.0，HR（次/min）：95.5±8.3比103.1±11.4，SOFA评分（分）：7.3±2.4比8.5±2.3，APACHEⅡ评分（分）：16.4±2.7比18.0±2.9，OI（mmHg）：314.5±80.1比241.6±60.3，PEEP（cmH2O，1 cmH2O＝0.098 kPa）：8.7±2.0比8.5±2.6，ScvO2：0.713±0.072比0.681±0.084，Lac（mmol/L）：2.0±1.1比2.7�ObjectiveTo explore the effect of low dose pituitrin（Pt） on biomarkers of cardiopulmonary injury, tissue perfusion, oxygen metabolism and prognosis in patients with septic shock.Methods A prospective randomized controlled trial was conducted, and 76 patients with septic shock treated with norepinephrine（NE） dosage≥0.2μg·kg-1·min-1 were enrolled in the study and randomly divided into two groups. A comprehensive management in accordance with the guidebook of adult septic shock hemodynamic detection and support was arranged early for the patients in the two groups, the standard group used NE alone, while the research group treatment was NE combined with low dose Pt（0.7-2.3 U/h）, under the maintenance of target blood pressure〔mean arterial pressure （MAP） 65 - 90 mmHg（1 mmHg=0.133 kPa）〕, NE or Pt was gradually reduced; if MAP〈65 mmHg, fluid infusion and / or increasing the dosage of NE could be carried out, and if MAP≥70 mmHg maintaining for more than 12 hours, hydrocortisone（HC） could be withdrawn. Before entrance and after entrance into the groups for 6, 24, 48 and 96 hours, the changes of MAP, heart rate（HR）,number of cases and frequency of stopping use of HC, dosesof NE usage, sepsis-related organ failure assessment（SOFA）score, acute physiology and chronic health evaluationⅡ（APACHEⅡ） score, oxygenation index（OI）, positive end-expiratory pressure（PEEP）, plasma N-terminal pro-B-type natriuretic peptide（NT-proBNP）, cardiac troponin T（cTnT）, creatine kinase isoenzyme（CK-MB）, central venous blood oxygen saturation（ScvO2）, blood lactic acid（Lac） and serum creatinine（SCr）were detected in the two groups; the NE application time, amount of fluid supplement in 24 hours, mechanical ventilation time,length of ICU hospital stay, 28-day total mortality and adverse reaction were observed in the two groups.Results Seventy-six patients with septic shock were included in this study. The baseline indicators in the twogroups had no statistical signif

关 键 词：休克 脓毒性 垂体后叶素 去甲肾上腺素 心肌肌钙蛋白T N末端B型脑钠肽前体 氧合指数 血乳酸 中心静脉血氧饱和度 

分 类 号：R631.4[医药卫生—外科学]