酚妥拉明对重症脓毒症患者微循环和肾功能的影响

Effects of phentolamine on microcirculation and renal function in patients with severe sepsis

目的:探讨酚妥拉明对重症脓毒症患者微循环的改善作用,以及对肾功能的影响。方法:采用数字表法将符合入选标准的重症脓毒症患者51例随机分为研究组和对照组。遵照SSC2012指南,2组给以常规治疗,研究组加用酚妥拉明治疗,观察患者治疗前后甲襞微循环、及肾功能的变化,记录治疗后的APACHEⅡ、ICU的入住天数和30 d的病死率。结果:研究组的甲襞微循环、血尿素氮(BUN)、肌酐(Scr)、尿量、尿乙酰-氨基葡萄糖苷酶(NAG)及γ-谷氨酞转肤酶(γ-GPT)改善优于对照组,差异具有统计学意义(P<0.05或P<0.01)。治疗后2组的ICU的入住天数、血液透析比率和30 d的病死率均有统计学意义(P<0.05或P<0.01)。结论:联合应用酚妥拉明能显著改善脓毒症患者早期微循环和肾脏的血流灌注,提高脓毒症患者的生存率及生存质量。

OBJECTIVE To investigate the ameliorating effects of phentolamine iniection on micrrculation and renal func- tion in patients with severe sepsis. METHODS Using random number table, 51 patients with severe sepsis were divided into research group and the control group. Following SSC 2012 guide, two groups of patients were given with conventional treat- ment. Phentolamine iniection was added in the ~herapy of research group. The changes of nailfold microcirculation and renal function in patients were observed before and after treatment. The APACHE ]] score was recorded after treatment and the hos- pitalized days in ICU, blood dialysis ratio and 30 d mortality were compared between the two groups. RESULTS The changes of the nailfold microcirculation,amount of blood urea nitrogen（BUN ） and serun creatinine（Scr）, the urine output, the urine level of N-acetyl-13-D- glucosaminidase （NAG） and T-glutamyl transpeptidase （7-GTP） in the research group were better than those in the control group, the differences were statistically significant （P〈0. 05 or P〈0. 01）. After the treatment, there were significant differences in the hospitalized days in ICU, blood dialysis ratio and 30 d mortality between the two groups （P〈0. 05 or P〈0. 01 ）. CONCLUSION The combined therapy of phentolamine injection can remarkably improve the microcircu- lation and the blood perfusion of the kidney in patients with early severe sepsis, but also improve the survival rate and quality of life.