不同晶体液早期复苏对感染性休克患者内环境的影响：一项前瞻性随机对照研究  

Effect of different crystalloids on internal environment in patients with septic shock receiving early fluid resuscitation： a prospective randomized controlled trial

作　　者：王小明 袁周 陈齐红[2] 於江泉[2] 郑瑞强[2] Wang Xiaoming;Yuan Zhou;Chen Qihong;Yu Jiangquan;Zheng Ruiqiang(Clinical Medical College,Yangzhou University,Yangzhou 225001,Jiangsu,China;Department of Critical Care Medicine,Northern Jiangsu People＇s Hospital,Yangzhou 225001,Jiangsu,China)

机构地区：[1]扬州大学临床医学院,江苏扬州225001 [2]江苏省苏北人民医院重症医学科,江苏扬州225001

出　　处：《中华危重病急救医学》2018年第9期824-829,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金（81670065）;江苏省社会发展重点专项（BE2017691）;江苏省扬州市科技计划项目（YZ2017086）

摘　　要：目的比较0.9% NaCl溶液、林格液、醋酸钠钾镁钙葡萄糖注射液（ASPMCG液）早期复苏对感染性休克患者内环境的影响。 方法采用前瞻性随机对照研究方法，选择2016年6月至2018年1月江苏省苏北人民医院重症医学科（ICU）连续收治的280例感染性休克患者，用随机数字表将患者分为0.9% NaCl溶液组（N组）、林格液组（L组）、ASPMCG液组（P组）。所有患者入组3 h内均留置右颈内静脉或锁骨下静脉导管，并输注相应晶体液30 m/g，6 h内根据患者液体复苏有无容量反应性来指导补液速度及液体量；研究期间其他治疗均参照2012年＂拯救脓毒症运动＂（SSC）指南进行。记录研究期间患者6 h和24 h液体复苏量、7 d内外源性胰岛素用量，观察复苏0、3、6、24 h和3 d、7 d动脉血pH值、剩余碱（BE）、血糖（Glu）、血乳酸（Lac）以及血Na＋、K＋、Cl-、Ca2＋水平的变化。 结果研究期间共1？082例患者入住ICU，排除不符合感染性休克诊断标准、入ICU 24 h内死亡或自动出院等患者，最终有280例感染性休克患者纳入分析，N组94例，L组94例，P组92例。3组患者6 h和24 h晶体液量、胶体液量、液体总量以及7 d内外源性胰岛素用量比较差异均无统计学意义。液体复苏后，3组患者血Cl-浓度均出现不同程度升高，24 h达峰值，但N组血Cl-明显高于L组和P组（mmo/：107.5±5.6比106.1±4.8、105.1±4.2，均P〈0.05）；血Ca2＋随复苏时间延长也呈升高趋势，3 h和6 h N组血Ca2＋明显低于L组和P组（mmo/：3 h为1.10±0.08比1.15±0.09、1.12±0.10，6 h为1.12±0.10比1.16±0.08、1.15±0.09，均P〈0.05）；而L组与P组间血Cl-和Ca2＋比较差异无统计学意义（均P〉0.05）。3组间液体复苏期间各时间点动脉血pH值、BE、Glu、Lac、Na＋、K＋比较差异也均无统计学意义。 结论在感染性休克早期液体复苏中，与林格液及ASPMCG液相比，0.9% NaCl溶液�ObjectiveTo compare the effect of 0.9% NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution （ASPMCG solution） on internal environment in patients with septic shock receiving early fluid resuscitation.MethodsA prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit （ICU） of Northern Jiangsu People＇s Hospital were enrolled. All eligible patients were randomly divided into 0.9% NaCl solution group （group N）, Ringer solution group （group L） and ASPMCG solution group （group P） with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 m/g of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign （SSC） guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess （BE）, blood glucose （Glu）, lactic acid （Lac）, and serum Na＋, K＋, Cl-, Ca2＋ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.ResultsIn this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was no significant difference in the amount of crystalloid, colloidal fluid, total fluid within 6 hours or 24 hours or exogenous insulin dose within 7 days among the three groups. After fluid resuscitation, blood Cl- concentration in the three groups was increased in different degrees, p

关 键 词：感染性休克 液体复苏 0.9%NaCl溶液 醋酸钠钾镁钙葡萄糖注射液 

分 类 号：R459.7[医药卫生—急诊医学]