特利加压素治疗超高龄患者感染性休克：36例临床分析

Terlipressin for treatment of very old septic shock patients： 36 cases analysis

目的分析特利加压素治疗超高龄（≥80岁）患者感染性休克的疗效及不良反应。方法选择2010年1月至2013年1月在南京军区南京总医院干部病房二科住院的超高龄（≥80岁）感染性休克患者36例，随机分为两组，A组18例患者使用多巴胺，其中经多巴胺治疗无效的患者改用特利加压素，B组18例患者直接使用特利加压素，观察并比较患者治疗前及治疗后24h的心率、平均动脉压、尿量、休克指数和治疗3d后血尿素氮、肌酐等，观察治疗效果与不良反应。结果经过治疗后，多巴胺组10例有效，8例多巴胺无效患者改用特利加压素后平均动脉压较前明显升高、休克指数明显下降，心率升高，差异具有统计学意义（P〈O．05）；18例直接使用特利加压素组平均动脉压明显升高、休克指数明显下降，对心率没有影响，与多巴胺组比较差异有统计学意义（P〈0．05）。使用多巴胺和特利加压素对患者尿量的增加差异无统计学意义（P〉0．05）。所有患者治疗3d后肾功能变化不明显，2例直接使用特利加压素患者出现压疮，其他患者均未见明显不良反应。结论特利加压素治疗超高龄（≥80岁）感染性休克的临床疗效优于多巴胺，在超高龄感染性休克患者的治疗中具有良好的临床应用前景。

Objective To investigate the clinical efficiency and adverse effects of terlipressin on septic shock in very old patients（ ≥ 80 years old）. Methods Thirty-six very old septic shock patients hospitalized in our department from January 2010 to January 2013 were randomly divided into 2 groups. Eighteen patients in group A were treated with dopamine first, and then the ineffective patients received alternative terlipressin treatment. The other eighteen patients in group B were treated with terlipressin. Their heart rate, mean arterial pressure（MAP）, urine volume, and shock index before and at 24h after treatment, and blood urea nitrogen and creatinine at 3d after treatment were observed and recorded. The efficiency and adverse effects were also compared and analyzed. Results After treatment, dopamine was effective for 10 cases in group A, and the left 8 ineffective patients in group A who received alternative terlipressin treatment got significantly elevated MAP, declined shock index, and raised heart rate（P 〈 0.05）. In group B, the similar change was observed in the changes of MAP and shock index, but not in the heart rate, and all these were significantly different with those in group A（P 〈 0.05）. There was no significant difference in the raised urine volumes between the 2 groups（P 〉 0.05）. At 3d after treatment, the renal function of all the patients had no obvious change. Two patients in group B were observed with bedsore. None of adverse effects was observed in the other patients. Conclusion Terlipressin is superior to dopamine in treatment of septic shock in very old patients（≥ 80 years old）, and has a good prospect of clinical application in septic shock treatment.