中心静脉压监测下硝酸甘油对感染性休克患者的影响

Effect of nitroglycerin on septic shock patients under the monitoring of central venous pressure

目的：比较在中心静脉压（CVP）的监测下，感染性休克患者术中血管活性药物的应用及对预后的影响。方法选取2012年12月至2013年12月于全身麻醉下行腹部急诊手术的感染性休克患者145例，其中69例（CVP 组）监测中心静脉压中35例 CVP≤12 mmHg（1 mmHg ＝0.133 kPa），34例 CVP≥13 mmHg，其余76例（对照组）未监测中心静脉压。术中根据血流动力学、每搏输出变异（SVV）及 CVP 选择输血、输液或血管活性药物，并记录术中的输液种类、输液量、失血量、输血量、尿量、手术时间、心率失常发生情况、血管活性药物的种类及剂量。术后所有患者统一送入 ICU，按照 ICU 的管理标准对待，并记录术后心力衰竭、肺部感染、肾脏损伤及并发症的发生率，术后 ICU 滞留时间，住院时间，病死率等。结果与对照组比较，CVP 组术中硝酸甘油的使用量明显增加（P ﹤0.05），两组心律失常发生率比较差异有统计学意义（P ﹤0.05）。CVP 组的 ICU 滞留时间、术后呼吸支持时间、肺部感染及心力衰竭发生情况明显少于对照组（P ﹤0.05），而肾脏损伤、病死率及总住院天数两组间比较差异未见统计学意义（P ﹥0.05）。结论在监测中心静脉压的情况下，对感染性休克患者使用硝酸甘油不仅减少了术中输液或输血的剂量，还在一定程度上降低了术后并发症的发生情况，但使用硝酸甘油对患者预后的长远影响及确定其合适剂量，仍需要进一步的研究。

Objective To observe the effects of using nitroglycerin under central venous pressure （CVP）monitoring in septic shock patients and the assessment of prognosis. Methods One hundred and forty-five patients with septic shock,ASA Ⅲ - Ⅳ,accepting abdominal emergency operation under gen-eral anesthesia from December 2012 to December 2013 were studied. Sixty-nine cases were received cen-tral venous pressure monitoring（CVP group）,in which,the CVP of 35 cases was less than or equal to 12 mmHg（1 mmHg = 0. 133 kPa）,the other 34 cases were greater than or equal to 13 mmHg. The re-maining 76 cases were without central venous pressure monitoring（control group）. During the operation, the transfusion,infusion and vasoactive drugs were selected according to the hemodynamics,stroke vol-ume variation（SVV）and CVP. The types of infusion,intraoperative transfusion volume,blood loss, blood transfusion volume,urine volume,operation time,arrhythmia occurrence and dosage of vasoactive drugs were recorded. All patients were transferred into the ICU after operation,and recorded the postop-erative pulmonary infection,heart failure,kidney damage and the incidence of complications,postopera-tive ICU retention time,hospital stay,mortality. Results The dosage of glycerin trinitrate of CVP group during the operation was higher than that of control group（P ﹤ 0. 05）. There were no significant differ-ence of the incidence of arrhythmia between CVP group and control group（P ﹥0. 05）. The ICU retention time,postoperative ventilation time,the incidence of pulmonary infection and heart failure of CVP group were significantly less than those of control group（P ﹤ 0. 05）,but the kidney damage,mortality rate and total hospitalization time between the two groups had no significant（P ﹥ 0. 05）. Conclusions Under the monitoring central venous pressure,the use of nitroglycerin in patients with septic shock not only re-trinitrate in patients with septic shock need further studied.