硝酸甘油对脓毒性休克患者复苏达标后微循环的影响  

Effect of nitroglycerin on the microcirculation after early goal directed therapy in patients with septic shock

作　　者：朱磊[1] 李斌[1] 李红[1] 曹永强[1] 窦志敏[1] 刘丽平[1] 

机构地区：[1]兰州大学第一医院重症医学科,兰州730000

出　　处：《解放军医学杂志》2016年第6期496-499,共4页Medical Journal of Chinese People's Liberation Army

基　　金：兰州大学第一医院院内基金(ldyyynlc201110)~~

摘　　要：目的评价硝酸甘油对脓毒性休克患者复苏达标后微循环及病死率的影响。方法选取2014年1月-2015年1月兰州大学第一医院重症医学科收治的符合脓毒性休克标准的患者,休克复苏达标后随机分为对照组和硝酸甘油组。对照组给予标准治疗,硝酸甘油组在标准治疗基础上,给予硝酸甘油0.5-1.0mg/h静脉泵入。入组后监测两组患者治疗后0、6、24、72h时的舌下微循环指标,包括小血管总密度（TVDs）、灌注小血管密度（PVDs）、灌注小血管比例（PPVs）、微血管流量指数（MFI）、异质性指数。记录患者ICU住院时间、总住院时间及随访28d病死率。结果入组53例患者,其中对照组26例,硝酸甘油组27例。治疗24、72h两组患者TVDs均未明显增加,而PVDs、PPVs、MFI、异质性指数在治疗6、24、72h时较入组时提高,治疗24、72h较6h明显升高。硝酸甘油组治疗72h各微循环指标明显高于对照组（P〈0.05）,机械通气时间明显低于对照组（P〈0.05）,ICU住院时间及总住院时间明显短于对照组（P〈0.05）,住院病死率及28d病死率均低于对照组（P〈0.05）。结论硝酸甘油对感染性休克复苏达标后患者微循环有显著改善作用,并可有效改善患者预后,降低机械通气时间、ICU停留时间、总住院时间以及病死率。Objective To evaluate the effect of nitroglycerin on the microcirculation and mortality after early goal directed therapy in patients with septic shock. Methods Fifty-three patients diagnosed as septic shock and admitted to our ICU from Jan. 2014 to Jan. 2015 were recruited and randomly divided into two groups after early goal directed therapy： nitroglycerin group（treated with standard early goal directed therapy and nitroglycerin 0.5-1.0mg/h, continuously intravenous pumped） and control group（treated only with standard early goal directed therapy）. The data of sublingual microcirculation were collected 0, 6, 24 and 72 hours after fluid resuscitation, which included total small vessel density（TVDs）, perfused small vessel density（PVDs）, proportion of perfused small vessels（PPVs）, microvascular flow index（MFI） and De Backer score. The length of ICU stay, total length of stay and the mortality on 28 days of following up were recorded. Results Of the 53 enrolled patients, 27 were assigned to the nitroglycerin group and 26 to the control group. There was no significant increase in TVDs at the points of 24 h and 72 h of treatment in the both groups. However, compared to that at the beginning of fluid resuscitation, the indexes of PVDs, PPVs, MFI and De Backer score increased at the 6, 24 and 72 hour points; and the data were also higher at the 24 and 72 hour points than at the 6 hour point; moreover, the nitroglycerin group showed significant increase at the 72 hour point compared with control group. Simultaneously, the reduced mechanical ventilation（MV） time（P〈0.05）, the shorter ICU stay（P〈0.05） and total hospital stay（P〈0.05）, the decreased in-hospital mortality（P〈0.05） and 28-day mortality（P〈0.05） were in nitroglycerin group than in control group. Conclusion Nitroglycerin can significantly improve the microcirculation in patients with septic shock after early goal directed therapy, decrease the mechanical ventilation time, shorten the ICU days and the lengt

关 键 词：硝酸甘油 休克 脓毒性 微循环 

分 类 号：R631.4[医药卫生—外科学]