小剂量垂体后叶素治疗难治性休克

Preliminary Clinical Study on the Use of Low-dosage Pituitrin in the Treatment of Refractory Shock

目的:评价小剂量垂体后叶素治疗难治性休克的临床作用。方法:回顾分析外科监护室2005年3月—2006年1月期间接受小剂量垂体后叶素治疗的17例难治性休克患者的临床资料。患者在液体复苏和儿茶酚胺类药物治疗基础上,给小剂量垂体后叶素(<0.04 U/min),在维持平均动脉血压≥65 mmHg的基础上逐步调整儿茶酚胺类药物的剂量。结果:应用垂体后叶素前平均儿茶酚胺整合剂量为13.63±3.8,应用8 h后该剂量为3.01±0.64(P<0.05);应用前平均尿量为1.25±0.92 ml·kg^(-1) h^(-1),8 h后为2.02±1.15 ml·kg^(-1)h^(-1)(P<0.05);应用前平均肌酐清除率为46.9±31.7 ml·min^(-1),8 h后为68.1±41.9 ml·min ^(-1)(P<0.05)。结论:小剂量垂体后叶素治疗难治性休克,可减少儿茶酚胺类血管活性药物的用量,同时可以改善患者的肾功能。

Objective：To study the effect of low-dosage pituitrin in clinical refractory shock. Methods：We retrospectively studied 17 cases of refractory shock admitted to the surgical intensive care unit of Zhongshan hospital between March, 2005 and January, 2006. Patients remained in shock despite volume resuscitation and administration of catecolamines were given low-dosage pituitrin（〈0. 04 U/ min）. When the mean arterial blood pressure was more than or equal to 65mmHg, the dosages of catecolamines were readjusted. Results： The mean integrated dosages of catecolamines were 13.63 ± 3.8 before administration of low-dosage pituitrin, and dropped to 3. 01 ± 0. 64 8 hours after administration（P〈0.05）. Mean urine output was 1.25 ± 0.92ml·kg^-1·h^-1 before administration, and 2. 02 ± 1.15 ml·kg^-1·h^-1 8 hrs after administration（P〈0. 05）. Mean creatinine clearance ratio was 46.9 ± 31.7ml·min^-1 before administration, and 68.1 ± 41.9ml·min^-1 8 hrs after administration（P〈0. 05）. Conclusion： Low-dosage pituitrin could decrease the dosages of catecolamines and improve renal function in patients with refractory shock.