静脉输注氨茶碱治疗严重脓毒症的可行性

Effects of aminophylline on cardiac index,oxygenation index,urine output and APACHEⅡ in patients with sepsis

目的观察静脉输注氨茶碱对严重脓毒症患者氧合指数、尿量、心脏指数和APACHEII评分的影响,探讨静脉输注氨茶碱治疗脓毒症的可行性。方法将60例APACHE评分>16分的脓毒症患者随机分为氨茶碱组(A组)和对照组(C组),每组30例。两组均予机械通气、按药敏或感染部位给予抗生素治疗、早期靶目标容量治疗和静脉输注小剂量肾上腺皮质激素治疗。观察组另外静脉输注氨茶碱,首先30 min内静脉输注负荷剂量3 mg/kg的氨茶碱,再以0.4 mg/(kg.h)持续静脉输注,持续4 d。两组均常规行桡动脉穿刺置管,连接MX950T传感器和Vigileo监测仪,以每搏量变异度为指导调整输液速度,持续监测心脏指数、每搏量变异度和有创动脉血压。于静脉输注氨茶碱前(T0)、输注氨茶碱后第一个24 h(T1)、第二个24 h(T2)和第三个24 h(T3)4个时间点抽取动脉血行血气分析;抽取外周静脉血3 ml测定氨茶碱血药浓度;记录每日尿量和总输液量。结果两组患者年龄、性别构成比、身高、体重、APACHEⅡ评分和每日总输液量差异无统计学意义(P>0.05);与C相比,A组静脉输注氨茶碱前心脏指数、氧合指数、尿量差异无统计学意义(P>0.05);与T0相比,两组氧合指数升高,尿量增加(P<0.05);与C组相比,A组T1、T2和T3氧合指数升高,尿量增加(P<0.05);与C组相比,A组心脏指数T0时差异无统计学意义(P>0.05),T1和T3升高(P<0.05);与C组相比,A组T3APACHEⅡ评分分值降低(P<0.05)。结论静脉输注氨茶碱可通过增加脓毒症患者尿量、改善氧合和心脏功能,从而降低APACHEⅡ评分,改善脓毒症患者的预后。

Objective To investigate the effects of aminophylline on cardiac index,oxygenation index and urine output in patients with sepsis.Methods Sixty APACHE II score＆gt; 16 points patients with spesis of both sexes,aged 22-76yr,were randomly divided into 2 groups（n=30 each） ： aminophylline group（group A） and control group（group C）.Mechanical ventilation,antibiotics according to susceptibility or the sites of infection,early goal-directed therapy and low-dose steroids were administered for septic shock in both groups.Aminophylline 3mg/kg was infused iv over 30 min and followed by an infusion at 0.4 mg/（kg·h） for 4 days.Cardiac index,stroke volume variation and invasive arterial blood pressure were continuously monitored.Blood samples were drawn for blood gas analysis calculating oxygenation index and for determination of aminophylline serum concentration before aminophylline infusion（T0） and at 24h（T1）,48h（T2） and 72 h（T3） following aminophylline infusion.Urine output and total daily infusion were recorded at T0-T3.Results There were no significant differences in age,gender ratios,height,weight,APACHE II scores,and total daily infusion between two groups（P＆gt;0.05）.Compared with group C,there were no significant differences in the total daily infusion,cardiac index,oxygenation index and urine output before intravenous infusion of aminophylline（P＆gt;0.05）.Compared with the values before intravenous infusion of aminophylline（T0）,oxygenation index and urine output increased in two groups（P＆lt;0.05）.Compared with group C,oxygenation index and urine output increased at T1,T2 and T3 increased in group A（P＆lt;0.05）.Compared with group C,there was no difference in cardiac index at T0（P＆gt;0.05）,but it increased at T1 and T3（P＆lt;0.05）.Compared with group C,APACHE II score decreased at T3（P＆gt;0.05）.Conclusion Intravenous infusion of aminophylline can increase urine output,oxygenation index and cardiac index in patients with sepsis.