感染性休克患者早期不同液体复苏对血流动力学及脑钠肽的影响

Effects of different fluid resuscitations on haemodynamic parameters and B-type natriuretic peptide during the early stage of septic shock

目的 探讨感染性休克患者不同液体早期复苏对血流动力学、血管外肺水（EVLW）及血浆脑钠肽（BNP）水平的影响.方法 选择60例感染性休克患者分为A组（n=32）和B组（n=28）,两组患者均按早期复苏目标导向治疗（EGDT）方案复苏,A组予6%羟乙基淀粉130/0.4溶液＋0.9%氯化钠注射液复苏,B组予0.9%氯化钠注射液复苏;分别于复苏前、复苏6 h、复苏 24 h、复苏48 h收集血流动力学参数、血管外肺水指数（EVLWI）、氧合指数（PaO2/FiO2）、血浆BNP等资料.结果 两组复苏后均可以明显改善感染性休克患者的血流动力学指标.A组复苏后48 h总液体量明显少于B组（P〈0.05）,肺血管渗透性指数（PVPI）、EVLWI和血浆BNP在液体复苏过程中差异均无统计学意义（P〉0.05）.B 组EVLWI、血浆BNP在复苏48 h明显升高（P〈0.05）.两组患者EVLWI与全心舒张末期容积指数（GEDVI）、胸内血容量指数（ITBVI）及PaO2/FiO2间均无明显的相关关系,与 PVPI、血浆BNP均有明显的正相关关系（r1=0.65,r2=0.58,均P〈0.05）.结论 感染性休克患者早期无论使用胶体或晶体液进行液体复苏,都可以改善感染性休克患者的血流动力学状态,且胶体液有更好的扩容效果,能更好地维持血浆胶体渗透压;感染性休克患者晶体液复苏有导致EVLW及BNP增加的危险,但不影响氧合功能.

Objective To determine the effect of different fluid resuscitations on haemodynamic parameters, extravascular lung water （EVLW） and plasma B - type natriuretic peptide （BNP） during the early stage of septic shock. Methods Sixty patients in early stage of septic shock were divided into group A （ n = 32） and group B （ n = 28）. Patients of two groups were given fluid resuscitation by early goal -directed therapy （EGDT）. Group A was given fluid resuscitation of 6% hydroxyethyl starch 130/ 0.4 （VOLUVEN） -0.9% NaC1 solution and group B of 0.9% NaC1 solution. The data of haemodynamic parameters, extravascular lung water index （EVLWI）, oxygenation index （PaO~/FiO2 ） and plasma BNP was determined before fluid resuscitation and 6 hour, 24 hour, 48 hour after fluid resuscitation （refers to the time begin to fluid resuscitation）. Results Fluid resuscitation significantly improved the hemodynamic parameters in the two groups＇patients with septic shock. The total amount of fluid of the patients in group A was significantly lower than that of the patients in group B at the time point of 48 hours after resuscitation （P 〈 0.05 ）. There was no change in pulmonary vascular permeability index （PVPI）, EVLWI and plasma BNP during fluid resuscitation of the patients in group A （P 〉0. 05）. EVLWI and plasma BNP of group B were significantly increased 48 hour after fluid resuscitation （ P 〈 0. 05 ）. EVLWI and plasma BNP of two groups＇patients with septic shock was not significantly correlated with global end - diastolic volume index （ GEDVI）, chest cavity blood volume index （ ITBVI）, PaO2/FiO2, but positively correlated with PVPI and plasma BNP （ r1 = 0. 65, r2 = O. 58, P 〈 0.05 ）. Conclusion Fluid resuscitation of both colloid and crystalloid could improve the haemodynamic parameters of the patient with septic shock. But colloid could better maintain colloid osmotic pressure and expend blood volume compared with erystalloid. EVLW and plasma BNP maybe increase in fluid resuscitation of crystal in the patient with septic shock in early stage.