前列腺素E_1对老年严重脓毒症和脓毒性休克患者舌下微循环的作用  

Effects of prostaglandin E_1 on sublingual microcirculation in elderly patients with severe sepsis and septic shock

作　　者：汪月奔 虞意华[1] 刘秉宇[1] 颜默磊[1] 严静[1] 

机构地区：[1]浙江医院重症医学科,杭州310013

出　　处：《中国临床药学杂志》2016年第3期137-140,共4页Chinese Journal of Clinical Pharmacy

基　　金：国家重大新药创制(编号2013ZX09303005);浙江省科技创新团队项目(编号:重症医学2001R50018);浙江省医药卫生科技计划项目(编号2010KYB013)

摘　　要：目的应用旁流暗视野仪观察前列腺素E_1(PGE_1)对严重脓毒症和脓毒性休克患者微循环的影响。方法采用数字表法将符合入选标准的严重感染患者34例遵照SSC 2012指南,早期目标导向复苏后,在常规"集束化"治疗的基础上,随机分为常规治疗组和PGE_1组,各17例。应用旁流暗视野技术观察患者治疗前后舌下微循环的变化。观察指标包括:总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)和微血管流动指数(MFI)。同时观察治疗前后宏循环指标的变化,记录2组APACHEⅡ评分和28 d病死率。结果 PGE_1组患者舌下微循环在给药后第1天PPV较入组时明显增加(77.21±2.72vs 75.5±7.67,P<0.05);治疗第7天,PPV、MFI较常规治疗组增加明显(86.60±6.74 vs 80.20±8.55,2.51±0.45 vs 2.19±0.46,P均<0.05)。心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、乳酸和中心静脉氧饱和度(Scv O2)及28 d死亡率在2组间比较差异均无统计学意义(P>0.05)。结论 PGE_1可改善老年严重脓毒症和脓毒性休克患者舌下微循环状况。舌下微循环指标可作为评估及指导严重脓毒症和脓毒性休克患者优化血流动力学治疗的重要方法,临床仍需更多的研究支持。AIM To evaluate the efficacy of prostaglandin E1 （PGEI） on sublingual microcirculation in elderly pa- tients with severe sepsis or septic shock through the sidestream darkfield imaging technique （SDF）. METHODS Thirty- four elderly patients with severe sepsis or septic shock were enrolled, 17 patients were randomly divided into the conven- tional treatment group, and the others were assigned into the PGE1 group in accordance with the random number table. All patient had a basic treatment of early goal-directed therapy （EGDT） and sepsis bundle therapy according to the SSC 2012 guideline. The main outcome measures included total vascular density（TVD）, perfusion vascular density（PVD）, proportion of perfused vessels（PPV） and mierovascular flow index（MFI） through SDF before and after treatment.The macrovaseular hemodynamic variables, APACHE Ⅱ score, and the 28-day mortality were recorded in 2 groups. RESULTS Compared to the conventional treatment group, the PPV increased significantly （77.21 ± 2.72 vs 75.5 ±7.67, P 〈 0.05） in PGE1 group in the first day after treatment, and the PPV, MFI were higher in PGEI group （86.60 ±6.74 vs 80.20 ±8.55, and 2.51 ±0.45 vs 2.19 ±0.46 respectively, P 〈 0.05） in the 7th day. There were no differences （ P 〉 0.05） in heart rates, mean arterial pressure, central venous pressure, lactate, central venous oxygen saturation and 28-day mortality between the 2 groups. CONCLUSION PGE1 improves the conditions of sublingual microcirculation in elderly patients with severe sepsis and septic shock. The parameters of sublingual microcirculation can be used as an important method to assess and guide the optimized hemodynamic treatment in patients with severe sepsis and septic shock, and more research is necessary to confirm these findings.

关 键 词：严重脓毒症 脓毒性休克 舌下微循环 旁流暗视野成像技术 前列腺素E1 

分 类 号：R459.7[医药卫生—急诊医学]