不同剂量血管加压素对脓毒症难治性休克患者血流动力学的影响

The Effect of the Different Dose of Teli Vasopressin in the Hemodynamics of the Patients with Septic Shock

目的:探讨不同剂量持续输注特立加压素(TP)对脓毒症难治性休克患者心脏及血流动力学的影响。方法:选取2013年1月-2014年5月本院及佛山市第一人民医院ICU科收治的脓毒症难治性休克患者60例,按随机数字表法分为治疗组(小、大剂量组)40例及对照组20例,患者(中心静脉压≥10 cm H2O,容量负荷试验阴性)均接受适当的液体治疗和去甲肾上腺素等血管活性药物治疗,而平均动脉压低于65 mm Hg后,小、大剂量组在原有治疗基础上,分别加用不同剂量TP输注(小剂量组为0.01 U/min,大剂量组为0.04 U/min),在维持平均动脉压≥65 mm Hg的基础上调节去甲肾上腺素药物剂量。分别观察给药前,给药6、12、24、48 h后各组患者的心率(HR)、平均动脉压(MAP)、心排出量指数(CI)、外周血管阻力指数(SVRI)等血流动力学指标及去甲肾上腺素用量变化。结果:与治疗前比较,治疗后6 h,各治疗组的MAP均显著升高,HR下降,差异均有统计学意义(P<0.05);各治疗组各时点的CI、SVRI均无明显改变,与治疗前比较差异均无统计学意义(P>0.05)。大剂量组MAP、HR、维持目标MAP(10.0 kPa)所需的去甲肾上腺素用量与小剂量组比较差异均无统计学意义(P>0.05);治疗12 h后,治疗组较对照组去甲肾上腺素用量减少,差异均有统计学意义(P<0.05)。结论:持续静脉泵泵注TP能有效改善感染性休克患者的血流动力学,降低去甲肾上腺素的使用剂量,且未明显增加心脏后负荷,因而可作为一种有效的血管加压素,用于感染性休克的治疗。小剂量与较大剂量间无显著性差异。

Objective：To explore the effects of different doses of vasopressin infusion of Teli vasopressin（TP） in the heart and hemodynamics of septic shock patients.Method：From January 2013 to May 2014,the department of ICU of our hospital and Foshan first people’s hospital,60 patients of refractory septic shock were randomly divided into the treatment group（small,high-dose group）for 40 cases and the control group for 20 cases. They were treated with appropriate fluid therapy（CVP≥10 cm H2O,capacity load test was negative）and norepinephrine and other vasoactive drug therapy. When mean arterial blood pressure below 65 mm Hg,the treatment group cured with different doses Teli vasopressin infusion（low-dose group was 0.01 U/min,high-dose group was 0.04 U/min）.Mean arterial pressure were maintaining ≥ 65 mm Hg basis through adjust the dose of nor-epinephrine.Before treatment and after treatment on 6,12,24,48 hours,the heart rate（HR）,mean arterial pressure（MAP）,cardiac output index（CI）,systemic vascular resistance index（SVRI）and other blood dynamics indicators and norepinephrine dosage changes were observed.Result：Compared with before treatment,the MAP was significantly increased,the HR was declined in TP treatment group after treatment 6 hour,the differences were statistically significant（P〈0.05）;the CI,SVR did not change significantly in the treatment group after treatment 6,12,24,48 hour,the differences were not statistically significant（P〉0.05）. Compared with the low-dose group,MAP,HR,maintain the target MAP（10.0 kPa）required amount of norepinephrine in the high dose group,the differences were not statistically significant（P〉0.05）. The amount of norepinephrine of The treatment group were reduced than the control group,the differences were statistically significant （P〈0.05）. Conclusion：TP continuous intravenous infusion pump can effectively improve hemodynamics in patients with septic shock,lower doses of norepinephrine,and no significant increase in cardiac afterload,thus can be used as an effective vasopressin,for the treatment of septic shock. No significant difference between small and large dose.