改良式早期目标指导治疗对感染性休克患者脏器功能的影响

Effect of modified early goal-directed therapy on organ functions of patients with septic shock

目的:探讨改良式早期目标指导治疗(EGDT)在治疗感染性休克时对患者脏器功能的影响。方法:116例感染性休克患者随机分为试验组(改良式EGDT组,n=57)和对照组(传统EGDT组,n=59),观察两组患者的临床症状改善情况,并分别测定液体复苏前(T0)及治疗后24 h(T1)、48 h(T2)及72 h(T3)血c Tn I、BNP、AST、ALT、TBA、BUN及Cr水平。结果 :两组年龄、性别构成和治疗前APACHEⅡ评分及其他监测指标比较差异均无统计学意义(P>0.05)。治疗后,试验组T1、T2、T3时点的血c Tn I、BNP水平和T2、T3时点的血AST、ALT、TBA、Cr及BUN水平均明显低于对照组(P<0.05)。结论:改良式EGDT能更显著地降低感染性休克患者血c Tn I、BNP、AST、ALT、TBA、Cr及BUN水平,对心肌、肝脏及肾脏损伤有保护作用。

Objective To investigate the effect of modified early goal-directed therapy （EGDT） on organ functions of patients with septic shock. Methods One hundred and sixteen patients with septic shock were randomly divided into two groups. Patients in the study group （n = 57） were treated with the modified EGDT program, and patients in the control group （n = 59） received the standard EGDT therapy. The concentrations of cardiac troponin I （cTnI）, B-type brain natriuretic peptide （BNP）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, total bile acid （TBA）, serum creatinine （Cr）, and blood urea nitrogen （BUN） in serum of all the patients were determined and recorded at the 0 h（the time before initiation of treatment）, 24 h, 48 h, and 72 h after the resuscitation. Results No significant differences between the study group and the control group were found in age, gender, APACHE Ⅱ score before treatment, and the blood level of cTnI, BNP, AST, ALT, TBA, Cr and BUN before treatment （P 〉 0.05, respectively）. After treatment, the blood levels of cTnI and BNP in the study group were significantly lower than those in the control group at the point of T1, T2 and T3 with significant differences （P 〈 0.05）. The blood levels of AST, ALT, TBA, Cr and BUN in the study group were significantly lower than those in the control group at the point of T2 and T3 with significant differences （P 〈 0.05, respectively）. Conclusions The modified EGDT can significantly decrease the infectivity of blood cTnI, BNP, AST, ALT, TBA, Cr and BUN levels of patients with septic shock,and can protect patients with septic shock against myocardial damage, liver damage and kidney injury.