特利加压素联合去甲肾上腺素在感染性休克中的应用

The effects of the terlipressin combined with norepinephrine on septic shock

目的：探讨特利加压素（TP）联合去甲肾上腺素（NE）对感染性休克患者血流动力学及乳酸清除率的影响。方法：感染性休克患者22例，随机分为对照组（10例）和试验组（12例），分别给予NE和NE＋TP治疗，观察用药前（TO），用药后6h（T6），48h（T48）患者的心率（HR）、平均动脉压（MAP）、血乳酸清除率、心脏指数（CI）、血管外肺水指数（EvLw）以及全身血管阻力（SVR）。结果：（1）与T0比较，T6～T48时2组患者的MAP、乳酸清除率明显升高，HR明显下降（P〈0．05）（2）2组去甲肾上腺素剂量在治疗后6h逐步下调，至观察结束试验组使用剂量明显低于对照组（P〈0．05），两组的心脏指数（CI）、血管外肺水指数（EVLW）以及全身血管阻力（svR）无明显差异（P〉0．05）。结论：在感染性休克患者中，小剂量持续输注TP联合NE，能有效改善其血流动力学，降低血乳酸水平和去甲肾上腺素的使用剂量。

Objective： To investigate the effects of low dose continuous infusion terlipressin（TP）combined with norepinephrine（NE）on hemodynamic vari- ables and clearance rate of blood lactate in patients with septic shock. Methods..22 patients with septic shock were divided into control group（10cases）and ex- periment group（12cases）, 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.clearance rate of blood lactate. CI.EVLW and SVR were made before infusion（T0）, after infusion at 6 hours（T6）, 12hours （T12） ,24hours（T24）and48 hours（T48）. Results.. （1）after 6 hours of treatment,MAP.clearance rate of blood lactate of the two groups were increased sig- nificantly, H R was decreased （P〈0.05）（2）The dose of norepinephrine were gradually reduced Mart treatment, to the end the close of experiment group was significantly lower than the control group（P 〈 0.05） ,but there were no significant difference between the two groups of cardiac index.extravascular lung wa- ter and systemic vascular resistance. Conclusion For the patients with septic shock,low-dose continuous infusion terlipressin combined with norepinephrine can effectively improve hemodynamies,decrease blood lactate and doze of norepinephrine.