左西孟旦治疗脓毒症休克对血清s TREM-1、s CD14和s CD163水平的影响  

Effects of levosimendan and dobutamine on serum levels of s TREM-1,s CD14 and s CD163 in treatment of sepsis shock

作　　者：王文[1] 胡芳宝 窦红杰 凌林 王德强 WANG Wen;HU Fangbao;DOU Hongjie;LING lin;WANG Deqiang(Department of Intensive Care Unit,South Branch of The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院南院上海市奉贤区中心医院重症加强护理病房,上海市200233

出　　处：《河北医药》2018年第21期3306-3309,共4页Hebei Medical Journal

摘　　要：目的研究左西孟旦和多巴酚丁胺治疗脓毒症休克的疗效及对血清可溶性髓样细胞触发受体^(-1)(s TREM^(-1)),可溶性白细胞分化抗原(s CD) 14和s CD163水平的影响。方法收治的脓毒症休克患者84例,按照治疗方法不同分为观察组和对照组,每组42例。对照组予以多巴酚丁胺治疗,观察组予以左西孟旦治疗。比较2组治疗后的疗效、机械通气时间、住院时间、住ICU时间、血管活性药物静脉使用时间(VDUT)和急性生理与慢性健康评分(APACHEⅡ),比较2组治疗前后左心室每搏做功指数(LVSWI),心排血指数(CI),血管外肺水指数(EVLWI),外周血管阻力指数(SVRI),平均动脉压(MAP),心率(HR),血乳酸,氧合指数(PO_2/FIO_2),s TREM^(-1),s CD14和s CD163水平的变化。结果观察组总有效率明显高于对照组(P <0. 05)。观察组的械通气时间,住院时间,住ICU时间,VDUT和APACHEⅡ评分明显短于或者少于对照组(P <0. 01)。2组治疗前LVSWI、CI、EVLWI、SVRI、MAP、HR、血乳酸、PO_2/FIO_2、s TREM^(-1)、s CD14和s CD163水平差异无统计学意义(P>0. 05);治疗后2组LVSWI、CI、SVRI、MAP和PO_2/FIO_2水平较治疗前明显升高(P <0. 01),EVLWI、HR、血乳酸、s TREM^(-1)、s CD14和s CD163水平较治疗前明显降低(P <0. 01),观察组升高或者降低水平较对照组更加显著(P <0. 01)。结论左西孟旦治疗脓毒症休克优于多巴酚丁胺,可能与提高心肌功能,稳定病情,促进机体的有氧呼吸,改善机体的炎性反应具有密切联系。Objective To investigate the therapeutic effects of levosimendan and dobutamine on sepsis shock,and observe their effects on the levels of sTREM-1,sCD 14 and sCD163 of patients with sepsis shock.Methods A total of 84 patients with sepsis shock who were treated in our hospital from January 2014 to December 2016 were divided into observation group(n=42)and control group(n=42)according to different treatment methods.The patients in control group were treated by dobutamine,however,the patients in observation group were treated by levosimendan.The therapeutic effects,the mechanical ventilation time,length of staying in hospital,length of staying in ICU,vasoactive drug venous use time(VDUT),acute physiology and chronic health score(APACHEⅡ)were observed and compared between the two groups.The levels of left ventricular stroke index(LVSWI),cardiac output index(CI),extravascular lung water index(EVLWI),peripheral vascular resistance index(SVRI),mean arterial pressure(MAP),heart rate(HR),Blood lactate,oxygenation index(PO 2/FIO 2),sTREM-1,sCD14 and sCD163 before and after treatment were also observed and compared between the two groups.Results The total effective rate was 92.86%in observation group,which was significantly higher than that(71.43%)in control group(χ2=5.194,P<0.05).The the mechanical ventilation time,length of staying in hospital,length of staying in ICU,VDUT and APACHEⅡscores in observation group were significantly less than those in control group(P<0.01).Before treatment there were no significant differences in LVSWI,CI,EVLWI,SVRI,MAP,HR,blood lactate,PO 2/FIO 2,sTREM-1,sCD14 and sCD163 between two groups(P>0.05),after treatment the levels of LVSWI,CI,SVRI,MAP and PO 2/FIO 2 were significantly increased in both groups(P<0.01),however,the levels ofEVLWI,HR,blood lactate,sTREM-1,sCD14 and sCD163 were significantly decreased in both groups(P<0.01),moreover,the increase degree and decrease degree in observation group were more significantly obvious than those in control group(P<0.01).Conclusion Levosimend

关 键 词：左西孟旦 脓毒症 可溶性髓样细胞触发受体-1 可溶性白细胞分化抗原 

分 类 号：R441.9[医药卫生—诊断学]