早期目标导向治疗对感染性休克患者心功能的影响

Effect of early goal-directed therapy on heart function in patients with septic shock

目的探讨早期目标导向治疗(EGDT)在治疗感染性休克时对患者心功能和预后的影响。方法 48例感染性休克患者分为试验组(S组,n=28)和对照组(C组,n=20)。试验组在感染性休克诊断明确入组后即开始EGDT;对照组则进行常规治疗,观察两组患者的临床症状改善情况,并分别测定液体复苏前(T0)及治疗后24 h(T1)、48 h(T2)及72 h(T3)血肌钙蛋白(IcTnI)、N末端B型利钠肽原(NT-proBNP)水平,以及液体复苏前(T0)及72 h(T3)后APACHEⅡ评分,计算住ICU时间以及28 d病死率。结果 S组患者T1、T2、T3时点的血cTn I和NT-proBNP水平显著低于对照组,差异有统计学意义(P<0.05);S组患者72 h时的APACHEⅡ评分以及住ICU时间较对照组明显降低(P<0.05);而两组患者28 d病死率差异无统计学意义(P>0.05)。结论 EGDT方案可以降低感染性休克患者血cTnI和NT-proBNP水平,对心肌损伤有保护作用,并缩短住ICU的时间。

Objective To investigate the effect of early goal- directed therapy （ EGDT ） on heart function and prognosis in the pa- tients with septic shock. Methods Forty-eight patients with septic shock were randomly divided into two groups. Patients in study group （group S, n=28 ） were treated with EGDT program, and control group （group C, n=20）with standard fluid resuscitation therapy. The concentra- tion of cardiac troponin I （ cTnI ） and N-terminal pro brain natriuretic peptide（NT-proBNP）in serum, and APACHEII score of all the patients were determined and recorded on the 0 h （ the time before initiation of treatment） and the 24 h, 48 h, and 72 h after the resuscitation. More- over, the days in ICU and the .28-day ratio were calculated in this research. Results The level of cTnI and NT-proBNP was higher in pa- tients with septic shock than that in the normal patients, and there was no difference between group S and C. After treatment, the level of cTnI and NT-proBNP in group S was decreased more obviously than that in group C at 24 h, 48 h, and 72 h（P〈 0.05） . APACHEII score and the days in ICU were decreased more significantly in group S than those in group C after the resuscitation（P〈 0.05） . There was no difference in the 28-day ratio between two groups （P〉0.05）. Conclusion The treatment of EGDT program could protect myoeardiac muscle, ameliorate heart function, and shorten the days in ICU for patients with septic shock.