前列腺素E1联合目标导向液体复苏对脓毒性休克治疗效果及血管内皮功能和组织灌注的影响  

Effect of prostaglandin E1 combined with target-oriented fluid resuscitation on septic shock,vascular endothelial function and tissue perfusion

作　　者：张佳琪 付淼 Zhang Jiaqi;Fu Miao(General Practice Department Baoji Central Hospital,Shaanxi 721008,China;不详)

机构地区：[1]陕西省宝鸡市中心医院全科医学科,721008 [2]陕西省宝鸡市中心医院急诊科,721008

出　　处：《山西医药杂志》2024年第4期253-257,共5页Shanxi Medical Journal

摘　　要：目的 探究前列腺素E1联合目标导向液体复苏对脓毒性休克临床效果及血管内皮功能和组织灌注水平的影响。方法 收集2019年1月至2021年12月在本院接受治疗的150例脓毒性休克患者,并应用随机数字表法将其均分为2组。对照组给予早期目标导向液体复苏治疗,观察组给予前列腺素E1与早期目标导向液体复苏的联合治疗。对比2组临床治疗效果、血管内皮功能和组织灌注水平。结果 与对照组比,观察组复苏液[(3 173±632)ml和(3 613±562)ml]和多巴酚丁胺[(53±10)mg和(64±7)mg]用量明显减少,复苏成功时间[(4.4±1.0)h和(4.7±1.1)h]和多巴酚丁胺用时[(5.2±1.6)d和(5.8±1.8)d]缩短,并发急性呼吸窘迫综合征(ARDS)率(1.3%和10.7%)明显下降,差异均具有统计学意义(P<0.05)。观察组复苏后6 h和复苏后48 h的急性生理与慢性健康评分(APACHEⅡ)评分[(17±5)分和(19±3)分、(13±5)分和(16±3)分]、序贯器官衰竭评分(SOFA)评分[(8.7±2.5)分和(9.8±2.8)分、(6.1±2.0)分和(7.4±2.4)分]水平均明显低于对照组,复苏后48 h的血清内皮素-1(ET-1)[(45±14)pg/ml和(50±15)pg/ml]、血栓调节蛋白(sTM)[(3.1±0.9)ng/ml和(3.7±1.1)ng/ml]、E-选择素(E-SLT)[(26±6)ng/ml和(28±6)ng/ml]、动脉血乳酸[(3.2±1.0)mmol/L和(3.6±1.0)mmol/L]、氧摄取量(O_(2)UR [(24±5)mmHg和(26±5)mmHg]均明显低于对照组,动脉血氧饱和度(SCVO_(2))[(81±7)%和(78±8%)]、外周血管阻力指数(SVRI)[(1 955±345)ds×m^(2)/cm^(5))和(1 826±413)ds×m^(2)/cm^(5))]明显高于对照组,差异均具有统计学意义(P<0.05)。结论 前列腺素E1联合目标导向液体复苏能有效减少脓毒性休克患者复苏液总用量,缩短液体复苏时间和血管活性药物使用时间,抑制机体血管内皮损伤,改善机体组织灌注水平和氧代谢状态,改善患者预后。Objective To explore the clinical effect of prostaglandin E1 combined with target-oriented fluid resuscitation on septic shock,vascular endothelial function,and tissue perfusion level.Methods One hundred and fifty patients with septic shock treated in our hospital from January 2019 to December 2021 were collected and divided into two groups by random number report method.The control group was given early goal-directed fluid resuscitation,while the observation group was given prostaglandin E1 combined with early goal-directed fluid resuscitation.The clinical therapeutic effect,vascular endothelial function,and tissue perfusion level were compared between the two groups.Results Compared with the control group,the dosage of resuscitation fluid[(3173±632)ml vs(3613±562)ml]and dobutamine[(53±10)mg vs(64±7)mg]in the observation group were significantly reduced.The successful resuscitation time[(4.4±1.0)h vs(4.7±1.1)h]and dobutamine time[(5.2±1.6)d vs(5.8±1.8)d]were shortened,and the rate of ARDS decreased significantly(1.3)%vs(10.7%),and the differences were statistically significant(P<0.05).The APACHEⅡscore[(17±5)vs(19±3),(13±5)vs(16±3)],SOFA score[(8.7±2.5)vs(9.8±2.8),(6.1±2.0)vs(7.4±2.4)]in the observation group at 6h and 48 h after resuscitation were significantly lower than those of the control group,the levers of serum ET-1[(45±14)pg/ml vs(50±15)pg/ml],sTM[(3.1±0.9)ng/ml]vs(3.7±1.1)ng/ml],E-SLT[(26±6)ng/ml vs(28±6)ng/ml],blood lactate[(3.2±1.0)mmol/L vs(3.6±1.0)mmol/L],O_(2)UR[(24±5)mmHg vs(26±5)mmHg]at 48 h after resuscitation were significantly lower than those of the control group,the levels of SCVO_(2)[(81±7)%vs(78±8)%],SVRI[(1955±345)ds×m^(5)/cm^(5) vs(1826±413)ds×m^(5)/cm^(5)]were significantly higher than those of the control group, and the differences were statistically significant (P<0.05). Conclusion Prostaglandin E1 combined with target-oriented fluid resuscitation can effectively reduce the total amount of resuscitation fluid in septic shock patients, shorten the time

关 键 词：脓毒性休克 预后 液体复苏 目标导向 前列腺素E1 

分 类 号：R459.7[医药卫生—急诊医学]