垂体后叶素与去甲肾上腺素对感染性休克并急性肾损伤的疗效研究  

The clinical study of pituitrin verse norepinephrine in the treatment of septic shock with acute kidney injury

作　　者：张素燕[1] 林金锋[1] 曹志龙 韩旭东[1] ZHANG Suyan;LIN Jinfeng;CAO Zhilong;HAN Xudong(Department of Critical Care Medicine,Nantong Third People's Hospital,Jiangsu Province,Nantong 226006)

机构地区：[1]江苏省南通市第三人民医院重症医学科

出　　处：《南通大学学报（医学版）》2019年第4期265-268,共4页Journal of Nantong University(Medical sciences)

基　　金：南通市卫生和计划生育委员会科研立项课题(WKZL2018061)

摘　　要：目的:探讨垂体后叶素能否降低感染性休克合并急性肾损伤的发生率,从而具有肾脏保护效应。方法:选取2014年1月-2018年12月收住我科的感染性休克患者295例,随机分为两组,观察组158例,对照组137例。对照组采用去甲肾上腺素治疗,观察组加用垂体后叶素1~2 U/h泵入。治疗7 d时对两组患者的肾功能进行比较。结果:感染性休克患者295例中入选时急性肾损伤155例(观察组90例,对照组65例),无急性肾损伤140例(观察组68例,对照组72例)。随着改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes, KDIGO)分期的增加,病死率增加。入选时急性肾损伤患者不管KDIGO分期如何,两组患者的病死率差异无统计学意义(P>0.05)。入选时无急性肾损伤患者在入院7 d中共有38例实施了肾脏替代治疗(renal replacement therapy, RRT),死亡24例。以7 d时需实施RRT或死亡为终点指标,观察组中无急性肾损伤患者的死亡率明显低于对照组(P<0.05)。结论:垂体后叶素对尚未发生感染相关性急性肾损伤患者具有肾脏保护效应,并可显著降低病死率,故垂体后叶素在临床的使用时机应该前移。Objective : To investigate whether pituitrin can reduce the incidence of acute kidney injury caused by septic shockand thus have a renal protective effect. Methods : A total of 295 patients with septic shock who were admitted to our department from January 2014 to December 2018 were randomly divided into two groups, 158 in the observation group and 137 in the control group. The main treatment methods are the same in both groups. However, in the selection of vasoactive drugs, in addition to norepinephrine, the observation group also used pituitary vasopressin to pump 1-2 U/h. Comparison of renal function status at 7 days of treatment was conducted. Results : Of the 295 patients with septic shock, 155 patients had acute kidney injury(90 in the observation group and 65 in the control group), and 140 patients had no acute kidney injury(including 68 in the observation group and 72 in the control group). As the Kidney Disease: Improving Global Outcomes(KDIGO) grading increases, the mortality rate increases. To patients with acute kidney injury at the time of enrollment in the study, regardless of the KDIGO classification, there was no significant difference in mortality between the observation group and the control group(P>0.05). In the absence of acute kidney injury at admission, a total of 38 patients underwent renal replacement therapy(RRT) and 24 died within 7 days of admission. At the 7 th day, RRT or death was required as the endpoint, the 140 patients with no acute kidney injury at the time of admission were analyzed according to whether or not the pituitrin was used. The results showed that the mortality of the observation group was significantly lower than that of the control group, and the difference was statistically significant(P<0.05). Conclusion : Pituitrin has a renal protective effect on patients without infection-related acute kidney injury and can significantly reduce the mortality rate. The timing of using pituitary vasopressin should be advanced in clinical.

关 键 词：感染性休克 急性肾损伤 改善全球肾脏病预后组织指南 垂体后叶素 去甲肾上腺素 

分 类 号：R631[医药卫生—外科学]