感染性休克应用小剂量血管加压素联合多巴胺治疗的临床疗效及安全性分析

Clinical efficacy and safety of low dose vasopressin combined with dopamine in treatment of septic shock

目的分析感染性休克应用小剂量血管加压素联合多巴胺治疗的临床疗效及安全性。方法选择2016年1月至2018年1月北京丰台医院接诊的100例感染性休克患者为研究对象,并随机分为研究组和对照组,各50例。其中,研究组患者进行液体复苏后泵入小剂量血管加压素联合多巴胺治疗,对照组患者进行液体复苏后泵入多巴胺治疗。比较2组患者治疗有效率,治疗前后右心室功能、左室射血分数(LVEF)、血浆N端脑钠肽原(NTproBNP)、炎性因子肿瘤坏死因子(TNF-α)和血清C反应蛋白(CPR)、血清降钙素原(PCT)、心肌肌钙蛋白1(cTn1)及治疗后的不良反应情况。结果对照组患者临床治疗总有效率为70.00%,明显低于研究组的92.00%,差异具有统计学意义(P<0.05)。2组患者治疗前的HR、SBP、尿量、血乳酸含量和乳酸清除率差异无统计学意义(P>0.05)。治疗后,2组患者的HR、血乳酸含量均下降,SBP、尿量和乳酸清除率均升高,且研究组患者的HR、血乳酸含量明显低于对照组,SBP、尿量和乳酸清除率明显高于对照组,差异具有统计学意义(P<0.05)。2组患者治疗前的RVEF、PVRI、CVP、RVEDVI、CI、PAWP、PCWI差异无统计学意义(P>0.05)。治疗后,2组患者的PVRI、CVP、RVEDVI、CI、PAWP水平均下降,RVEF、PCWI水平均升高,且研究组患者的PVRI、RVEDVI、CI、PAWP水平明显低于对照组,RVEF、PCWI水平明显高于对照组,差异具有统计学意义(P<0.05),CVP比较差异无统计学意义(P>0.05)。2组患者治疗前的LVEF、NT-proBNP水平差异无统计学意义(P>0.05)。治疗后,2组患者的LVEF水平均升高,NT-proBNP水平均下降,且研究组患者的LVEF水平明显高于对照组,NT-proBNP水平明显低于对照组,差异具有统计学意义(P<0.05)。2组患者治疗前的TNF-α、CPR、PCT、cTn1水平差异无统计学意义(P>0.05)。治疗后,2组患者的TNF-α、CPR、PCT、cTn1水平均下降,且研究组患者的TNF-α、CPR、PCT、cTn1水平明显低于对照组,差异具有统计学意义(P<0.05)。2组患者治疗后,研究组患者的总不良反应率为6.00%,明显低于对照组的34.00%,差异具有统计学意义(P<0.05)。结论应用小剂量血管加压素联合多巴胺治疗感染性休克临床效果极佳,明显改善心功能,降低炎性反应及PCT、cTn1水平,减少死亡率,值得在临床上广泛推广。

Objective To analyze the clinical efficacy and safety of low dose vasopressin combined with dopamine in treatment of septic shock. Methods From January 2016 to January 2018 in our hospital 100 cases of septic shock patients as the research object, and randomly divided into study group and control group, 50 cases in each. The patients in study group were treated with fluid resuscitation after infusion of low dose of vasopressin combined with dopamine treatment, the control group was treated with fluid resuscitation after infusion of dopamine treatment. Compare the effective rate of treatment in 2 groups, right ventricular function before and after treatment, left ventricular ejection fraction（LVEF）, plasma N-terminal pro-brain natriuretic peptide（NT-proBNP）, inflammatory factor tumor necrosis factor（TNF-α） and serum C Reactive protein（CPR）, serum procalcitonin（PCT）, cardiac troponin 1（cTn1） and adverse reactions after treatment. Results The total effective rate of the control group was 70%, which was significantly lower than that of the study group（92%）, and the difference was statistically significant（P0.05）. There was no significant difference in HR, SBP, urine volume, lactate content and lactate clearance rate between the two groups before treatment（P0.05）. After treatment, the contents of HR and blood lactate in the two groups were all decreased, and the levels of SBP, urine and lactic acid were all increased, and the content of HR and blood lactic acid in the study group was significantly lower than that of the control group. The SBP, urine volume and lactic acid clearance rate were significantly higher than those in the control group, the difference was statistically significant（P0.05）. There was no significant difference in RVEF, PVRI, CVP, RVEDVI, CI, PAWP and PCWI between the two groups before treatment（P0.05）. After treatment, the levels of PVRI, CVP, RVEDVI, CI and PAWP in the two groups were all decreased, and the levels of RVEF and PCWI were all higher, and the level of PVRI, RVEDVI, CI and PAWP in the study group was significantly lower than that of the control group, and the RVEF and the levels were significantly higher than those in the control group. The difference was statistically significant（P0.05）. There was no significant difference in the levels of LVEF and NT-proBNP between the two groups before treatment（P0.05）. After treatment, the level of LVEF in the two groups increased and the NTpro BNP water decreased, and the LVEF level of the patients in the study group was significantly higher than that of the control group. The level of NT-proBNP was significantly lower than that of the control group. The difference was statistically significant（P0.05）. There was no significant difference in the levels of TNF-α, CPR, PCT and cTn1 between the two groups before treatment（P0.05）. After treatment, the levels of TNF-α, CPR, PCT and cTn1 in the two groups were all decreased, and the level of TNF-α, CPR, PCT and cTn1 in the study group was significantly lower than that of the control group. The difference was statistically significant（P0.05）. After treatment, the total adverse reaction rate of the two groups was 6%, which was significantly lower than that of the control group（34%）, and the difference was statistically significant（P0.05）. Conclusion The clinical effect of small dose of vasopressin combined with dopamine in the treatment of septic shock is very good. It can improve the heart function, reduce the inflammatory reaction and PCT, cTn1 and reduce the mortality. It is worth popularizing in clinic.