碳酸氢钠林格液与复方氯化钠注射液治疗脓毒性休克的效果比较  

Application of sodium bicarbonate Ringer′s solution and compound sodium chloride injection in patients with septic shock

作　　者：郭卫东 高尚兰 姚童翔 GUO Weidong;GAO Shanglan;YAO Tongxiang(Intensive Care Unit,East District,Xinxiang Central Hospital(the Fourth Clinical College,Xinxiang Medical University),Xinxiang,Henan 453000)

机构地区：[1]新乡市中心医院(新乡医学院第四临床学院)东院区重症医学科,河南新乡453000

出　　处：《郑州大学学报（医学版）》2024年第1期87-91,共5页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191327)。

摘　　要：目的:比较碳酸氢钠林格液、复方氯化钠注射液用于脓毒性休克的治疗效果。方法:选取2019年4月至2022年4月新乡市中心医院收治的脓毒性休克患者80例,分为A、B组,每组40例。A组接受碳酸氢钠林格液注射液限制性液体复苏,B组接受复方氯化钠注射液限制性液体复苏。比较两组患者复苏处理后0、1、3、6、12、24、48 h乳酸清除率,复苏第0、6、12、24、48 h电解质指标(K^(+)、Na^(+)、Cl^(-)),血流动力学恢复稳定时间(中心静脉压恢复时间、平均动脉压恢复时间),ICU住院时间,死亡率以及0、6、12、24、48 h快速序贯器官衰竭评分(qSoFA评分),48 h内所用液体总量,不良事件发生率。结果:0~48 h,两组乳酸清除率均呈升高趋势,A组高于B组(P<0.05)。两组不同时间点K^(+)、Na^(+)水平差异无统计学意义(P>0.05),Cl^(-)水平有随时间升高的趋势,且A组12、24、48 h Cl^(-)水平低于B组(P<0.05)。与B组相比,A组中心静脉压恢复时间、平均动脉压恢复时间、ICU住院时间更短,死亡率更低(P<0.05)。qSoFA评分有随时间降低的趋势,且A组12、24、48 h qSoFA评分低于B组(P<0.05)。A组48 h内所用液体总量少于B组(P<0.05)。两组不良事件发生率差异无统计学意义(P=0.644)。结论:碳酸氢钠林格液限制性液体复苏治疗脓毒性休克效果更好。Aim:To explore the application value of sodium bicarbonate Ringer′s solution and compound sodium chloride injection in treatment of septic shock.Methods:A total of 80 patients with septic shock admitted to Xinxiang Central Hospital from April 2019 to April 2022 were allocated into group A and group B,with 40 in each group.Group A received sodium bicarbonate Ringer′s solution restricted liquid resuscitation,and group B received compound sodium chloride injection restricted liquid resuscitation.The lactate clearance rate at 0,1,3,6,12,24,48 hour,electrolyte indexes(K^(+),Na^(+),Cl^(-))at 0,6,12,24,48 hour after resuscitation,hemodynamic stabilization time[central venous pressure(CVP)recovery time,mean arterial pressure(MAP)recovery time],ICU stay and mortality were compared between the 2 groups.Rapid sequential organ failure score(qSoFA)at 0,6,12,24,48 hour,total fluid volume used within 48 hours,and adverse event rate were also compared.Results:The lactic acid clearance rate within 48 hours in both groups increased,which was higher in group A compared with group B(P<0.05).There was no significant difference in K^(+)or Na^(+)between the 2 groups at different time points(P>0.05);at 12,24,and 48 hour,Cl^(-)in group A was lower than that in group B(P<0.05).Compared with group B,group A had shorter CVP recovery time,MAP recovery time,ICU stay,and lower mortality(P<0.05).qSoFa in both groups decreased with time;compared with group B,patients in group A had lower qSoFA scores at 12,24,and 48 hour(P<0.05).There was no significant difference in the incidence of adverse events between group A and group B(P>0.05).Compared with group B,the total liquid volume used within 48 hours in group A was significantly less(P<0.05).Conclusion:Compared with compound sodium chloride injection,patients with septic shock who receive sodium bicarbonate Ringer′s solution restricted liquid resuscitation have better outcome.

关 键 词：碳酸氢钠林格液 复方氯化钠注射液 脓毒性休克 液体复苏 

分 类 号：R459.7[医药卫生—急诊医学]