酚妥拉明对重症脓毒症患者血流动力学的影响

Effects of phentolamine on haemodynamics of patients with severe sepsis

目的探讨酚妥拉明对重症脓毒症患者血流动力学的影响。方法2015年1月至2016年8月将南宁市第二人民医院五象医院急诊科和南宁市红十字会医院重症医学科符合入选标准的重症脓毒症患者59例采用数字表法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、治疗后6、12、24、48、72h均应用脉搏指示连续心排血量监测（PiCCO）进行心指数（CI）、胸腔内血容积指数（ITBVI）、血管外肺水指数（EVLWI）、全身血管阻力指数（SVRI）的变化；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，观察两组患者的28d生存率以及重症医学科（ICU）住院时间。结果治疗后12、24、48、72h研究组CI、SVRI、ITBVI较对照组明显增高，EVLWI明显下降。研究组的血乳酸水平、乳酸清除率在治疗后的12、24、48、72h时间点改善优于对照组，特别是6h乳酸清除率研究组比较对照组明显增加[（27．2±2．2）mmol／L比（13．9±3．0）mmol／L，t=8．322，P=0．034]。研究组患者ICU的入住时间和28d的病死率明显少于对照组[（9．8±3．6）d比（13．0±4．1）d，P=0．004；（22．6％比35．7％，P=0．021）]。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流动力的变化趋势，提高脓毒症患者的生存率。

Objective To explore the effects of phentolamine on hemodynamic of patients with severe sepsis , Methods From January 2015 to August 2016, using random number table ,59 patients with severe sepsis were divided into research group and the control group by conventional treatment in Department of Emergency, the Second People＇s Hospital of Nanning City. The patients of the research group were given phentolamine injection. The CI,ITBVI,EVLWI,SVR1 of the patients were monitored by PICCO on 6, 12, 24, 48, 72 h before and after treatment. Measuring clearance of blood lactic acid, lactic acid, comparing two groups of blood lactic acid, lactic acid clearance change tendency, 28 d survival rate and time of the two groups in the ICU of patients was observed. Results CI, SVRI, ITBVI of the research group was increased obviously,and EVLWI decreased obviously（P 〈 0.05 or P 〈 0. 01 ）12, 24, 48, 72 h after treatment. The levels of blood lactic acid, lactic acid clearancef the research group improved better than that of the control group（P 〈 0. 05 or P 〈 0. 01 ） after treatment of 12, 24, 48, 72 h time points, especially lactate clearance increased significantly than the control group[ （27.2 ± 2. 2） mmol/L vs （13.9 ± 3.0） mmol/L, t = 8. 322, P = 0. 034 ] on 6 h. Time in ICU and 28 days rate of the research group was less than the control group [（9.8±3.6） d vs（13.0 ± 4.1） d,P= 0.004 ; （22.6% vs 35.7%,P= 0.021）] . Conclusion Phentolamine can significantly improve the early condition of hemodynamic and the survival rates of patients with severe sepsis.