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 Vasopressin On the Hemodynamics of the Patients with Septic Shock

目的:探讨不同剂量特立加压素(TP)对脓毒症难治性休克患者血流动力学的影响。方法:选取本院收治的84例脓毒症难治性休克患者作为研究对象,按随机数字表分为大、小剂量组(每组42例),比较两组患者经不同剂量血管加压素输注后各组患者血流动力学的变化。结果:两组患者经不同剂量血管加压素治疗后,平均动脉压(MAP)、心率(HR)、心脏指数(CI)、全身血管阻力(SVR)较治疗前相比均有显著改善,但两组改善程度无显著性差异(P>0.05),两组患者经治疗后休克指数均明显降低,排尿量显著增加,同时两组患者经治疗后乳酸清除率与混合静脉血液饱和度较治疗前相比均有改善,且改善程度基本一致(P>0.05)。结论:大小剂量的TP治疗对于脓毒性难治性休克患者均有较好的疗效,但较大剂量血管加压素的使用与小剂量相比在血流动力学上并没有显著的差异,因此对于脓毒性难治性休克患者推荐使用在充分液体复苏的基础上,采用小剂量持续输入TP同时联合去甲肾上腺素进行治疗。

Objective：To investigate the effect of the different dose of vasopressin on the hemodynamics of the patients with septic shock.Method：84 cases of patients with septic shock treated in our hospital were selected as the research group, which were individed into small dose group and high dose group.The hemo-dynamics of the two group was observed.Result：The mean arterial pressure （ MAP ） , heart rate （ HR） , car-diac index （ CI） and systemic vascular resistance （ SVR） of the two groups were significantly improved com-pared to before the treatment, but the improvement degree in the two groups had no significant difference （ P〉0.05） .The shock index of the two groups were significantly lower,while the urine output was significantly increased, the clearance of lactic acid and mixed venous blood saturation were aslo improved after treatment, and the degree of improvement was almost the same （P 〉0.05）.Conclusion： Small and high dose of TP therapy for patients with septic shock refractory both has good curative effect, but the high dose vasopressin has no significant difference in hemodynamic compared with small dose .Therefore septic patients with refrac-tory shock is recommended on the basis of fully liquid recovery with small dose of continuous input TP joint norepinephrine treatment.