低剂量琥珀酸氢化可的松与去甲肾上腺素和多巴胺联合早期集束化方案对感染性休克患者治疗效果分析

Effect of low-dose hydrocortisone succinate,norepinephrine,dopamine combined with early clustering regimen on treatment of patients with septic shock

目的探讨低剂量琥珀酸氢化可的松、去甲肾上腺素、多巴胺联合早期集束化方案治疗对感染性休克患者早期目标指导性治疗(6hEGDT)达标率、病死率的影响。方法选取2016年1月-2017年1月医院收治的感染性休克患者84例,按治疗方式不同将84例患者分为两组,每组各42例,对照组患者给予低剂量琥珀酸氢化可的松、去甲肾上腺素、多巴胺等常规药物治疗,联合组患者在常规治疗基础上联合早期集束化方案治疗,比较两组患者治疗后6h、24h、48h的心率(Heartrate,HR)、动脉压(MAP)、中心静脉压(CVP)、中心静脉血氧饱和度(ScvO2)及血清乳酸清除率;同时比较两组每小时平均尿量、住院时间、6hEGDT达标率、多器官功能障碍(MODS)发生率及病死率。结果联合组治疗后6h、24h、48hHR水平均低于对照组,MAP、CVP、ScvO2水平均高于对照组(P<0.05);联合组治疗后6h、24h血清乳酸清除率均高于对照组(P<0.05),48h比较差异无统计学意义;联合组每小时平均尿量高于对照组,住院时间短于对照组(P<0.05);联合组6hEGDT达标率高于对照组,MODS发生率及病死率低于对照组(P<0.05)。结论对感染性休克患者在低剂量琥珀酸氢化可的松、去甲肾上腺素、多巴胺等常规治疗基础上联合早期集束化方案治疗的效果较好,提高6hEGDT达标率,且改善患者预后。

OBJECTIVE To explore the effect of low-dose hydrocortisone succinate,norepinephrine,dopamine combined with early clustering regimen on compliance rate of 6 hearly goal-directed therapy（6 hEGDT）and mortality rate of patients with septic shock.METHODS A total of 84 patients with septic shock who were treated in the hospital from Jan 2016 to Jan 2017 were enrolled in the study and divided into two groups according to the treatment approaches,with 42 cases in each group.The control group was treated with low-dose hydrocortisone succinate,norepinephrine and dopamine,while the combined group was given additional early clustering regimen on basis of the conventional therapy.The heart rate（HR）,mean arterial pressure（MAP）,central venous pressure（CVP）,central venous oxygen saturation（ScvO2）and clearance rate of serum lactic acid were compared between the two groups of patients after the treatment for 6,24 and 48 hours.The average urine volume,length of hospital stay,6 hEGDT compliance rate,incidence of multiple organ dysfunction（MODS）and mortality rate were compared between the two groups of patients.RESULTS The HR of the combined group was significantly lower than that of the control group after the treatment for 6,24 or 48 hours,the MAP,CVP and ScvO2 of the combined group were significantly higher than those of the control group（P〈0.05）.The clearance rates of serum lactic acid of the combined group were significantly higher than those of the control group after the treatment for 6 and 24 hours（P〈0.05）,and there was no significant difference in the clearance rate of serum lactic acid after the treatment for 48 hours.The average urine volume of the combined group was significantly greater than that of the control group,and the length of hospital stay of the combined group was significantly shorter than that of the control group（P〈0.05）.The 6 hEGDT compliance rate of the combined group was significantly higher than that of the control group,and the incidence of MODS and mortality rate were significantly lower in the combined group than in the control group（P〈0.05）.CONCLUSION The low-dose hydrocortisone succinate,norepinephrine,dopamine combined with early clustering regimen can achieve remarkable effect on treatment of the patients with septic shock,raise the 6 hEGDT compliance rate and improve the prognosis of the patients.