垂体后叶素治疗肠源性脓毒性休克的临床研究

Clinical study of pituitrin in treatment of gut-derived septic shock

目的探讨垂体后叶素对肠源性脓毒性休克患者的临床价值。方法入选2013年6月至2017年3月期间南通市第三人民医院重症医学科连续收治的肠源性脓毒性休克患者64例,随机数字表法分为常规组和垂体后叶素组,其中常规组30例,垂体后叶素组34例。根据2012年国际脓毒症救治指南实施救治,常规组使用去甲肾上腺素3 mg以生理盐水配制成50 ml溶液,单独经深静脉导管泵入。垂体后叶素组在上述治疗基础上加用垂体后叶素24 U以生理盐水配制成48 ml溶液,以0.5~2.0 U/h速度经深静脉导管泵入。收集两组患者入科时及治疗24 h后的心率(HR)、平均动脉压(MAP)、腹内压(IAP)、去甲肾上腺素用量、白细胞(WBC)、血小板(PLT)、乳酸(Lac)、总胆红素(TBIL)、血肌酐(SCr)、空腹血糖(FBG)、氧合指数(OI)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和序贯器官衰竭估计评分(SOFA)以及28 d病死率。计量资料用均数±标准差(x±s)表示,两组比较采用t检验,多组比较采用单因素方差分析。计数资料用百分率表示,组间比较采用x^2检验或Fisher确切概率法。结果两组患者治疗前HR、MAP、IAP、WBC、PLT、Lac、TBIL、SCr、FBG、OI、去甲肾上腺素用量、APACHEⅡ评分及SOFA评分等差异无统计学意义(P>0.05)。相比治疗前,治疗24 h后常规组HR及去甲肾上腺素用量增加,WBC、FBG及SOFA评分下降,垂体后叶素组HR、IAP、WBC、FBG、Lac、去甲肾上腺素用量及SOFA评分下降,差异有统计学意义(P<0.05)。治疗24 h后,垂体后叶素组患者的HR、Lac、IAP及去甲肾上腺素用量明显低于常规组,差异有统计学意义(P<0.05),其OI高于常规组,但差异无统计学意义(P=0.066)。常规组和垂体后叶素组的28 d病死率分别为46.66%和35.29%,差异无统计学意义(P=0.355)。结论联合使用垂体后叶素可显著减少肠源性脓毒性休克患者的去甲肾上腺素用量,减慢心率,有助于降低IAP及Lac水平,具有较好的临床应用价值。

Objective To analyze the clinical value of pituitrin in treatment of the patients with gut-derived septic shock.Methods A prospective randomized controlled trial was conducted on the patients with gut-derived septic shock admitted to the Intensive Care Unit of our hospital from June 2013 to March 2017.The enrolled 64 patients were randomized into routine treatment group and pituitrin treatment group.According to the International Sepsis Treatment Guideline in 2012, the patients of the routine treatment group were given 50 ml normal saline containing 3 mg norepinephrine,while those from the pituitrin treatment group were given 24 U pituitrin and 48 ml normal saline through deep venous catheter.Heart rate（HR）, mean arterial pressure（MAP）, intra-abdominal pressure （IAP）,dosage of norepinephrine,white blood cell count（WBC）,platelet count（PLT）,lactic acid（Lac）,total bilirubin（TBIL）, serum creatinine（SCr）,fasting blood glucose（FBG）,oxygen index（OI）,acute physiology and chronic health evaluation system Ⅱ（APACHEⅡ）score and sequential organ failure assessment score（SOFA）at admission and 24 h after treatment were measured,and the mortality within 28 d was observed.The quantitative data were expressed as mean ±standard deviation（（x）±s）.The comparison between groups was conducted with Student＇s t test,and that among groups was analyzed with univariate variance analysis.Enumera-tion data were expressed as percentage,and inter-group comparison was carried out with Chi-square test or Fisher＇s exact test.Results There were no significant differences in HR, MAP, IAP, WBC, PLT, Lac, TBIL, SCr, FBG, OI, dosage of norepinephrine, APACHEⅡscore and SOFA score before the treatment between the 2 groups（P〉0.05）.Compared with the baseline data,the routine treatment group had increased HR and the dosage of norepinephrine, but decreased WBC,FBG and SOFA score, while the pituitrin treatment group had reduced HR, IAP, WBC, FBG, Lac, dosage of norepinephrine and SOFA score in 24 h after treatment （P〈0.05）.The decreases of HR,Lac,IAP and dosage of norepinephrine were more significant in the pituitrin treatment group than the routine treatment group（P〈0.05）, and the former group had higher OI, though without obvious difference（P=0.066）.The mortality rates within 28 d were 46.66% and 35.29% respectively in the routine treatment group and the pituitrin treatment group （P=0.355）.Conclusion Combined injection of pituitrin can reduce the dosage of norepinephrine, slow HR down, decrease IAP and Lac level in the patients with gut-derived septic shock.The agent shows better clinical value for the patients.