限制性补液复合去甲肾上腺素对脓毒性休克患者血流动力学及氧代谢的影响  

Effect of Limited fluid Resuscitation Combined with Norepinephrine on Hemodynamics and Oxygen Metabolism in Septic Shock

作　　者：陶伟民 薛珉[2] 沈国锋[2] 江帆[3] 邹赛男 TAO Wei-min;XUE Min;SHEN Guo-feng;JIANG Fan;ZOU Sai-nan(ICU Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine,Shanghai,201204,China;Department of Respiratory Medicine,Shanghai Minhang Hospital,Fudan University,Shanghai,201199,China;ICU Tongren Hospital,Shanghai Jiaotong University,Shanghai,200090,China)

机构地区：[1]同济大学附属第一妇婴保健院ICU,上海201204 [2]复旦大学附属闵行医院呼吸与危重症医学科,上海201199 [3]上海交通大学医学院附属同仁医院ICU,上海200090

出　　处：《现代生物医学进展》2019年第12期2291-2294,共4页Progress in Modern Biomedicine

基　　金：上海复旦大学附属闵行医院基金项目(2018MHLC01)

摘　　要：目的:探讨限制性补液复合去甲肾上腺素对脓毒性休克患者血流动力学及氧代谢的影响。方法:将62例脓毒性休克患者按照液体复苏策略随机分为限制性液体复苏(治疗组)和常规液体复苏(对照组),每组各31例。观察和比较复苏前后血流动力学指标、氧代谢指标的变化,记录两组低血压、弥散性血管内凝血(DIC)、多器官功能障碍综合征(MODS)、急性呼吸窘迫综合症(ARDS)的发生率及2周病死率。结果:治疗后1 h、3 h、6 h,两组患者CVP、MAP明显升高,HR明显下降(P<0.05);治疗后3 h、6 h,治疗组MAP明显低于对照组(P<0.05),而两组HR、CVP比较差异均无统计学意义(P>0.05)。治疗后1 h、3 h、6 h,两组患者PaCO2、PaO2、SaO2、PaO2/Fi O2均不同程度改善,治疗组治疗后3 h、6 h PaO2、PaO2/Fi O2明显高于对照组(P<0.05)。治疗后3 d,治疗组MODS的发生率较对照组显著降低(P<0.05),而两组低血压、ARDS、DIC及2周病死率均无显著性差异(P>0.05)。结论:限制性液体复合小剂量去甲肾上腺素对脓毒性休克患者有助于维持血流动力学稳定,改善全身氧代谢,减少并发症的发生,改善预后。Objective: To explore the impact of limited fluid resuscitation combined with norepinephrine on hemodynamics and oxygen metabolism in septic shock. Methods: 62 patients of septic shock were divided randomly two groups according to resuscitation methods. Treatment group(n=31) was given limited fluid resuscitation, control group(n=31) was given conventional fluid resuscitation.Changes of indicators of hemodynamics and oxygen metabolism were observed, and incidence of DIC, MODS, ARDS and mortality within 2 weeks were recorded. Results: At 1 h, 3 h and 6 h after treatment, levels of CVP and MAP were increased significantly, and HR was decreased significantly in the two groups(P<0.05). At 3 h, 6 h after treatment, MAP level of the treatment group was significantly lower than that of the control group(P<0.05), while there was no statistically significant difference in HR and CVP between the two groups(P>0.05). At 1 h, 3 h and 6 h after treatment, the PaCO2, PaO2, SaO2 and PaO2/Fi O2 were all improved in different degrees in the two groups, and at 3 h, 6 h after treatment, PaO2 and PaO2/Fi O2 were significantly higher in the treatment group than those in the control group(P<0.05). After 3 d treatment, the incidence of MODS in the treatment group was significantly lower than that in the control group(P<0.05), while there was no significant difference between the two groups in hypotension, ARDS, DIC and mortality within 2 weeks(P>0.05). Conclusions: Limited fluid resuscitation combined with small dose of norepinephrine for septic shock can contribute to maintain hemodynamic stability, improve oxygen metabolism, reduce the occurrence of complications and improve the prognosis.

关 键 词：限制性补液 脓毒性休克 血流动力学 氧代谢 

分 类 号：R631.4[医药卫生—外科学]