小剂量持续输注特立加压素对感染性休克患者心脏及血流动力学的影响

The Effect of the Low-dose Continuous Infusion of Teli Vasopressin in the Heart and Hemodynamics of the 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月至2009年5月,中国人民解放军第309医院普外科共收治感染性休克患者245例,其中25例去甲肾上腺素抵抗患者给予小剂量TP每24小时2mg持续静脉泵泵注。将25例患者按最终的存活情况分为2组:存活组18例和死亡组7例。观察2组患者治疗前,治疗后6、12、24、48h的心脏〔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变化情况。结果与治疗前比较,治疗后6h,存活组、死亡组的MAP均显著升高,差异均有统计学意义(均P<0.05);2组治疗后6、12、24、48hCI、PAWP、SVR均无明显改变,差异均无统计学意义(均P>0.05)。死亡组7例中,急性呼吸窘迫综合征1例,多脏器功能障碍综合征6例。与死亡组比较,存活组MAP较高(治疗后6h)、HR较低(治疗后12h)、维持目标MAP(10.0kPa)所需的去甲肾上腺素用量较小(治疗后24h),差异均有统计学意义(均P<0.05)。结论小剂量持续静脉泵泵注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 explore the effect of the low-dose continuous infusion of teli vasopressin （TP） in the heart and hemodynamics of the septic shock patients. Methods From January 2008 to May 2009,the department of general surgery of the Cinese people＇s liberation army 309th Hospital, receive and cure to 245 cases of septic shock patients, of which 25 cases with resisting norepinephrine were treated to low-dose TP 2 mg in 24 hour, with continuous pump intravenous infusion. According to the ultimate survival,the 25 patients were terminal survival state divided into 2 groups.18 patients in the survival group and 7 patients in the death group. Observed two groups patients, before treatment and after treatment on 6,12,24,48 hours, the heart [heart rate （HR）, cardiac index （CI）], hemodynamic parameters [pulmonary artery wedge pressure （PAWP）,mean arterial pressure （MAP）, systemic vascular resistance （SVR）] and norepinephrine doses and other variations. Results Compared with those before of treatment, the survival group and death group were significantly higher MAP after treatment 6 hour,the differences were statistically significant （all P〈0.05）. The CI, PAWP, SVR of two groups were no obvious change with after of treatment at 6,12,24,48 hours, the differences were no significant difference （all P〉0.05）. In the 7 cases of the death group, 1 case was died of acute respiratory distress syndrome,6 cases were died of the multiple organ dysfunction. Compared with the death group,the survival group MAP was higher （after of treatment 6 hour）, HR was low （after of treatment 12 hour）,the maintenance of target MAP （10.0 kPa） required a smaller amount of noradrenaline （after of treatment 24 hour）, the differences were statistically significant （all P〈0.05）. Conclusion Low-dose continuous intravenous pump infusion of TP can effectively improve the blood flow in patients with septic shock dynamics,reducing the use of norepinephrine dose,and did not significantly increase cardiac afterload, which can be used as an effective vasopressin, used for the treatment of septic shock.