酚妥拉明对重症脓毒症患者血乳酸及预后的影响

Phentolamine blood lactic acid and prognosis in patients with severe sepsis

目的探讨酚妥拉明对重症脓毒症患者血乳酸的变化趋势及预后的影响。方法采用数字表法将符合入选标准的重症脓毒症患者55例随机分为研究组和对照组。遵照SSC2012指南，两组给予常规治疗，研究组加用酚妥拉明治疗，在患者入院治疗前及治疗后6、12、24、48、72h分别进行急性生理与慢性健康状况评分Ⅱ（APACHEⅡ），测量血乳酸、乳酸清除率，比较两组血乳酸、乳酸清除率的变化趋势；观察两组患者ICU入住天数、急性肾衰竭需透析率、机械通气时间和28d病死率。结果治疗后12、24、48、72h研究组APACHEⅡ评分较对照组明显下降（P〈0．05或P〈0．01）。研究组在治疗后12、24、48、72h时间点血乳酸水平、乳酸清除率改善优于对照组（P〈0．05或P〈0．01）。特别是6h乳酸清除率研究组较对照组明显增加（27．23±2．16vs．13．92±2．96，t=8．322，P〈0．05）。研究组患者ICU入住天数、急性肾衰竭需透析率、机械通气时间和28d病死率明显少于对照组（P〈0．05或P〈0．01）。结论联合应用酚妥拉明能显著改善重症脓毒症患者早期血乳酸变化趋势和微循环血流灌注，提高脓毒症患者生存率及生存质量。

Objective To explore the effect of phentolamine on blood lactic acid in patients with severe sepsis trends, as well as its influence on prognosis. Methods Using random number table, 55 patients with severe sepsis were divided into research group and the control group. The patients of both groups received conventional treatment following the SSC 2012 guide, except the patients in research group were additionally given phentolamine injection. Before and 6, 12,24,48,72 h after treatment, the APACHE Ⅱ was respectively calculated, and the blood lactic acid, lactic acid clearance were also recorded and compared between two groups. ICU stay, acute renal failure need dialysis rate, mechanical ventilation time and the mortality of 28 days were also recorded in the two groups. Results After treatment, APACHE Ⅱ score in research group was significantly lower than that in the control group （P 〈 0.05 or P 〈 0.01 ）. 12,24,48,72 h after treatment, the levels of blood lactic acid, lactic acid clearance in research group improved better than that of control group; the difference has statistical significance （P 〈 0.05 or P 〈 0.01 ）. Especially the 6 h lactate clearance in research group increased significantly compared with control group （27.23±2.16 vs. 13.92±2.96, t = 8.322, P 〈 0.05）. ICU stay, acute renal failure need dialysis rate, mechanical ventilation time and the mortality of 28 days were all less than those of the control group, with statistical significance （P 〈 0.05 or P 〈 0.01 ）. Conclusion Combined use of phentolamine can significantly improve the early blood laetic acid in patients with severe sepsis and changing trends of the blood perfusion of microcirculation, increase of survival rate and quality of life of the patients with sepsis.