特利加压素联合去甲肾上腺素对高龄感染性休克患者血乳酸清除率及肾灌注的影响

The effects of the terlipressin combined with norepinephrine on clearance rate of blood lactate and renal perfusion in the elderly patients with septic shock

目的探讨小剂量持续输注特利加压素(TP)联合去甲肾上腺素(NE)对高龄感染性休克患者血乳酸清除率和肾灌注的影响。方法高龄感染性休克患者48例,随机分为对照组(22例)和试验组(26例),分别给予NE和NE+TP治疗,观察用药前(T_0),用药后6 h(T_6)、12 h(T_(12))、24 h(T_(24))、48 h(T_(48))的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血乳酸清除率、每小时尿量(UV)和肌酐清除率(CCr)、滤过水排泄分数(FEH_2O)、滤过钠排泄分数(FENa)变化。结果 (1)血流动力学及血乳酸清除率:与T_0比较,T_6～T_(48)时2组患者MAP、乳酸清除率明显升高,HR明显下降(P<0.05,P<0.01)。与对照组比较,T_6～T_(48)时试验组HR明显降低(P<0.05),MAP、乳酸清除率明显增高(P<0.05),2组CVP差异无统计学意义(P>0.05)。(2)肾灌注情况:与T_0比较,T_6～T_(48)时2组UV、CCr、FEH_2O升高,FENa下降(P<0.05,P<0.01);与对照组比较,试验组UV、CCr、FEH_2O升高(P<0.05),FENa降低(P<0.05)。结论小剂量持续输注TP联合NE,能有效改善感染性休克患者的血流动力学,降低血乳酸水平,改善肾灌注,且未发现明显与TP相关的不良反应,因此可以用于高龄感染性休克患者的治疗。

Objective To study the effects of the low dose continuous infusion of terlipressin（TP） combined with norepinephrine（NE） on clearance rate of blood lactate and renal perfusion in the elderly patients with septic shock.Methods 48 elderly patients with septic shock were divided into control group（22 cases） and experiment group（26 cases）.Based on conventional treatment,NE was used in control group,and the low dose continuous infusion of TP combined with NE was used in experiment group.Serial measurements of HR,MAP,CVP,clearance rate of blood lactate,urine volume（UV）, CCr,FENa,FEH_2O were made before infusion（T_0）,after infusion at 6 hours（T_6）,12 hours（T_（12））,24hours（T_（24）） and 48 hours（T_（48））.Results Six hours after treatment,HR,FENa in experiment group were decreased significantly compared with that of control group at the same time point（P0.05）.MAP,clearance rate of blood lactate,UV,CCr,FEH_2O increased significantly in experiment group compared with that of the same time point in control group（P0.05）.CVP was no difference between two groups（P0.05）.Conclusion The low dose continuous infusion of TP combined with NE can effectively improve the blood flow in patients with septic shock dynamics,decrease blood lactate,increase renal perfusion,and did not significantly increase adverse events,which can be used for the treatment of the elderly patients with septic shock.