前列地尔对脓毒性休克复苏达标患者急性肾损伤的影响

Effect of alprostadil on acute kidney injury after resuscitation to standard state for septic shock

目的探讨前列地尔对脓毒性休克复苏达标患者急性肾损伤(AKI)的影响。方法采用随机、单盲、安慰剂对照的研究方法,入选2015年11月-2016年11月入住兰州大学第一医院重症医学科,明确诊断为脓毒性休克AKI,按早期目标导向治疗(EGDT),复苏达标后随机分为前列地尔组(PGE组,28例)和对照组(28例)。PGE组患者在常规药物治疗的基础上,静脉内应用前列地尔10μg+100ml生理盐水缓慢静注,2/d,连续应用7d。对照组患者静脉内以同样的方式、剂量及速度给予生理盐水。比较两组患者一般基线资料,监测两组患者治疗前、治疗后第3、5、7天的24h尿量、血肌酐(Cr)、尿素氮(BUN)、24h尿蛋白定量、尿NAG(N-乙酰-B-氨基葡萄糖苷酶)、γ-GTP、α_1-微球蛋白及血、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL),并观察患者2周内需要行持续肾脏替代治疗(CRRT)的百分率、病死率、ICU住院天数。结果治疗前两组患者的上述指标比较,差异均无统计学意义(P>0.05);治疗后与对照组比较,PGE组24h尿量明显增加,尿NAG、γ-GTP、α_1-微球蛋白、Cr、BUN及血、尿NGAL明显下降,PGE组患者2周内需要行CRRT的百分率、病死率、ICU平均观察天数低于对照组,差异均有统计学意义(P<0.05)。结论前列地尔可改善脓毒性休克AKI患者的肾功能,降低病死率,减少CRRT百分率及ICU住院天数,减少医疗费用及医疗资源的消耗。

Objective To study the effects of alprostadil on acute kidney injury after resuscitation to standard state in septic shock patients. Methods Adopting the method for random, single blind and placebo controlled trial, the patients diagnosed with acute kidney injury due to septic shock at Department of ICU, First Hospital of Lanzhou University during November 2015 to November 2016 were recruited in this study. According to early goal-directed therapy（EGDT）, the patients after resuscitation were randomly divided into alprostadil group（PGE group, n=28） and control group（CON group, n=28）. The patients of PGE group received the basis treatment of conventional therapy plus a slow intravenous infusion of alprostadil 10μg＋100 ml saline, 2 times a day for 7 days. The patients of CON group were given physiological saline in the same way, dose and speed. The general baseline data were compared between the two groups of patients. The vital signs, 24-hour urine output, serum creatinine（Cr）, urea nitrogen（BUN）, 24-hour urine protein and urinary NAG（N. acetyl-B-amino acid）, gamma-GTP, alpha 1-microspheres, blood and urine neutrophil gelatinase associated lipocalin（NGAL） were monitored before and 3 rd, 5 th and 7 th day after the therapy, and the percentage, mortality rate and ICU day of continuous renal replacement therapy（CRRT） observed for 2 weeks. Results There was no significant difference in the above indexes between the two groups before treatment（P〉0.05）. Compared with the CON group after treatment, 24-hour urine output increased, urine NAG, gamma-GTP, alpha 1-microglobulin, blood and urine NGAL serum creatinine and BUN decreased significantly, and the percentage, mortality rate and the average ICU days of the patients needing CRRT within 2 weeks were also lower in PGE group, with statistically significant differences（P〈0.05）. Conclusion Alprostadil can improve the renal function of the patients with septic shock and acute kidney injur y, lower the mortality, and reduce the percentage of CRRT and ICU hospitalization days, thus reducing the medical cost and the consumption of medical resources.