低剂量持续泵入特立加压素对感染性休克患者血流动力学的影响分析

Effect of Low Dose Continuous Infusion of Terlipressin on Cardiac Hemodynamics in Septic Shock Patients

目的:探讨小剂量持续输注特立加压素(TP)对感染性休克患者心脏及血流动力学的影响。方法:2008年1月～2009年5月解放军第309医院普外科收治的感染性患者45例,其中25例去甲肾上腺素抵抗患者给予小剂量TP持续静脉泵泵入2mg·(24h)-1治疗。按患者最终的存活情况分为存活组18例,死亡组7例,记录2组治疗前、治疗后6、12、24、48h心脏的[心率(HR)、心脏指数(CI)]血流动力学参数[肺动脉楔压(PAWP)、平均动脉压(MAP)、全身血管阻力(SVR)]和去甲肾上腺素剂量等。结果:与治疗前比较,治疗6h后,存活组、死亡组的平均动脉压均显著升高,差异均有统计学意义(P<0.05),而心脏指数(CI)、肺动脉楔压(PAWP)、以及全身血管阻力(SVR)均无明显改变,差异均无统计学意义(P>0.05)。与死亡组比较,存活组MAP较高(治疗6h后)、心率较低(治疗12h后),维持目标MAP(9.975kPa)所需的去甲肾上腺素剂量较小(治疗24h后),差异均有统计学意义(P<0.05)。结论:小剂量持续泵入TP能有效改善感染性休克患者的血流动力学,降低去甲肾上腺素的使用剂量,且未明显增加心脏后负荷,因而可作为一种有效的血管加压素,用于感染性休克的治疗。

OBJECTIVE：To investigate the effect of low-dose continuous infusion of vasopressin TP on cardiac hemodynamics in patients with septic shock.METHODS：Of the total 45 infection cases admitted to the surgical department of our hospital from Jan.2008 to May 2009,25 who are resistant to norepinephrine were given continuous intravenous low-dose TP venous pump infusion（2 mg/24 hours）.Of the 25 cases,18 survived（survival group） and 7 died（death group）.The heart rate,cardiac index,hemodynamic parameters of pulmonary artery wedge pressure（PAWP）,mean arterial pressure（MAP）,systemic vascular resistance（SVR） and noradrenaline dosage and so on were recorded at 0,6,12,24 and 48 hours.RESULTS：Compared with before treatment,the mean arterial blood pressure were significantly increased at 6 hours in both the survival group and the death group,and the differences in both groups were all statistically significant（P 0.05）,while the cardiac index（CI）,pulmonary artery wedge pressure（PAWP）,and systemic vascular resistance（SVR） showed no significant change,and the differences were all nonsignificant（P 0.05）.Compared with the death group,the survival group showed higher MAP at 6h,lower heart rate at 12h,and smaller dosage of the norepinephrine at 24h for maintenance of target MAP（9.975kPa）,and the differences were all statistically significant（P 0.05）.CONCLUSION：Low-dose continuous pumping of TP can effectively improve the hemodynamics in patients with septic shock and reduce the dosage of norepinephrine required yet without significant increase of cardiac afterload,which thus can be used as an effective vasopressin for the treatment of septic shock.