醋酸林格液联合琥珀酰明胶用于脓毒症的液体复苏研究

The research of acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients

目的探讨醋酸林格液联合琥珀酰明胶用于脓毒症患者液体复苏的临床意义。方法将59例脓毒症患者随机分为两组：乳酸林格液＋羟乙基淀粉组（A组，27例）和醋酸林格液＋琥珀酰明胶组（B组，32例），观察两组液体复苏的效果及期间各项参数指标的变化。结果两组患者治疗过程中的中心静脉压、平均动脉压和去甲肾上腺素总的用量比较，差异均无统计学意义（P〉0．05）。A组患者活化部分凝血活酶时间长于B组[6、24h分别为（58±10）、（74±13）s和（48±7）、（54±11）s]，纤维蛋白原浓度低于B组[6、24h分别为（3．3±0．8）、（1．6±0．3）g/L和（4．2±1．1）、（2．1±0．2）g／L]，差异有统计学意义（P〈0．05）。A组患者血清乳酸、肌酐、钙水平均高于B组，差异有统计学意义（P〈0．05）。第3天两组患者急性生理学与慢性健康状况Ⅲ评分比较，差异无统计学意义（P〉0．05）。结论醋酸林格液联合琥珀酰明胶用于脓毒症患者液体复苏有与乳酸林格液联合羟乙基淀粉相似的效果，但对于凝血功能、血清乳酸水平、肾功能的影响更少，可能更适用于脓毒症患者的液体复苏，但更容易发生低钙血症，也没有可以改善脓毒症患者预后的证据。

Objective To research the clinical significance of acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients. Method Fifty-nine sepsis patients were divided into two groups： lactic acid Ringer solution and hetastarch （group A, 27 cases）and acetated Ringer solution and succinylated gelatin （group B, 32 cases）, compared the fluid resuscitation and other parameter. Results There were no significant difference in the central venous pressure, mean arterial pressure and the dose of noradrenaline （P〉 0.05 ）. The activated partial thromboplastin time in group A was longer than that in group B[（58 ±10）,（74±13）s vs（48 ±7）, （54 ± 11 ） s in 6, 24 hours], fibrinogen concentration was lower than that in group B [ （3.3 ±0.8 ）, （ 1.6 ± 0.3 ）g/L vs （4.2 ± 1.1 ）, （2.1 ± 0.2）g/L in 6, 24 hours ] （P 〈 0.05 ）. Serum lactic acid, creatinine, calcium concentration in group A [ （6.9 ± 0.8）mmol/L, （289 ± 27） μmol/L, （2.1 ± 0.3）mmol/L]were higher than those in group B [（3.2 ± 1.1）mmol/L, （193 ±42）μmol/L, （1.7 ±0.2） mmol/L]（P〈 0.05）, there was no difference in APACHEⅢ scores on the third day between two groups （P〉 0.05）. Conclusions Acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients has the same effect, but fewer impacts on serum coagulation, serum lactic acid and renal function than lactic acid Ringer solution and hetastarch. They may be more suitable for fluid resuscitation of sepsis patients, but hypocalcemia is easy to happen, and there is no significant evidences proving the prognosis.