感染性休克后期血管加压素分泌调节异常的预后价值  

Prognostic value of decreased vasopressin modulation in the late-phase of septic shock patients

作　　者：周庆明[1] 杨秀芬[1] 孙静娜[2] 王春玲[2] 李栋梁[1] 

机构地区：[1]河北医科大学第一医院ICU,石家庄050031 [2]河北医科大学第一医院检验科,石家庄050031

出　　处：《中华危重病急救医学》2014年第10期706-709,共4页Chinese Critical Care Medicine

基　　金：河北省医学科学研究重点课题计划（20110319）

摘　　要：目的：探讨感染性休克后期患者血管加压素（VP）分泌调节异常的预后价值。方法采用前瞻性研究方法，选取2012年1月至2014年2月入住河北医科大学第一医院重症监护病房（ICU）的感染性休克患者55例，测定其输注3%氯化钠溶液（高渗盐水）前后血钠及血清VP水平，以△VP/△Na≤0.5 pg/mmoL为无反应组，＞0.5 pg/mmoL为有反应组，比较两组患者血乳酸、C-反应蛋白（CRP）水平、多巴胺（DA）和去甲肾上腺素（NE）等血管活性药物应用情况，以及28 d病死率、死亡患者的生存时间和存活患者ICU住院时间的差异。绘制受试者工作特征曲线（ROC曲线）分析VP的预后价值。结果无反应组30例（占54.5%），有反应组25例（占45.5%）。两组患者年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、中心静脉压（CVP）、血压、血清白蛋白水平以及输注高渗盐水前后血钠水平差异均无统计学意义。无反应组基础VP水平显著低于有反应组（ng/L：10.66±1.57比17.13±5.12，t＝6.091，P＜0.001），输注高渗盐水后VP水平仍显著低于有反应组（ng/L：11.65±1.74比22.50±5.31，t＝9.758，P＜0.001）。与有反应组比较，无反应组血乳酸（mmol/L：3.04±0.55比2.28±0.38，t＝-5.881，P＜0.001）、CRP（mg/L：117.9±23.0比94.9±17.0，t＝-4.143，P＜0.001）、应用血管活性药物剂量〔DA（μg·kg^-1·min^-1）：14.8±3.9比8.9±1.6，t＝-5.725，P＜0.001；NE（μg·kg^-1·min^-1）：0.96±0.42比0.40±0.09，t＝-5.625，P＜0.001〕均明显升高；28 d病死率明显升高（66.7%比40.0%，χ^2＝3.911，P＝0.048）；死亡患者的生存时间无差异（d：5.8±1.9比6.1±2.3，t＝0.384，P＝0.704）；存活患者ICU住院时间明显延长（d：9.9±2.3比6.7±1.7，t＝-4.044，P＝0.001）。ROC曲线分析显示，以△VP/△Na为0.5 pg/mmol作为判定预后的标准，敏感度为66.7%，特异度为64.0%，ROC曲线�Objective To investigate the prognostic value of decreased vasopressin （VP）modulation in the late-phase of septic shock. Methods A prospective study was conducted. Fifty-five septic shock patients hospitalized in intensive care unit （ICU）of the First Hospital of Hebei Medical University from January 2012 to February 2014 were enrolled. All patients received 3% hypertonic saline solution infusion. Serum concentrations of sodium and VP were measured before and after hypertonic saline solution infusion. Patients with ratio of difference in sodium and VP before and after infusion of 3%hypertonic saline （△VP/△Na）≤0.5 pg/mmol were defined as non-responders,and who〉0.5 pg/mmol were defined as responders. The levels of lactic acid,C-reactive protein （CRP）,and vasoactive drug〔dopamine（DA）and norepinephrine（NE）〕usage between the two groups were compared. The 28-day mortality,live time in the dead,and ICU day in survivors were analyzed between the two groups. The receiver operating characteristic curve （ROC curve）was drawn to assess prognostic value of VP. Results There were 30 cases （54.5%） in non-responsive group,and 25 （45.5%）in responsive group. There were no significant differences in the age,acute physiology and chronic health evaluationⅡ （APACHEⅡ）score,central venous pressure （CVP）,blood pressure, plasma albumin level,sodium level before and after hypertonic saline solution infusion between the two groups. The baseline level of VP in the non-responsive group was markedly lower than that of the responsive group （ng/L：10.66± 1.57 vs. 17.13 ±5.12,t=6.091,P〈0.001）. After hypertonic saline solution infusion,the VP level was also significantly decreased compared with that in the responsive group（ng/L：11.65±1.74 vs. 22.50±5.31,t=9.758,P〈0.001）. The non-responders showed higher lactic acid （mmol/L：3.04±0.55 vs. 2.28±0.38,t=-5.881,P〈0.001） and CRP （mg/L：117.9±23.0 vs. 94.9±17.0,t=-4.143,P〈0.001）,and received larger dosage of va

关 键 词：血管加压素 感染性休克 预后 渗透压 

分 类 号：R459.7[医药卫生—急诊医学]