不同剂量去甲肾上腺素对感染性休克患者血流动力学、核转录因子κB和人核因子κB抑制蛋白α的影响比较

Comparison of the effects of different doses of norepinephrine on hemodynamics,NF - κB and IκB - α in patients with septic shock

目的 探讨大剂量去甲肾上腺素对感染性休克患者血流动力学、核转录因子 κB（NF-κB）和人核因子 κB抑制蛋白 α（IκB-α）的影响.方法 选取2016年1月至2017年1月台州市中心医院救治的感染性休克患者50例,采用随机数字表法分为两组各25例.对照组应用小剂量（1～30μg/min）去甲肾上腺素治疗,研究组应用大剂量（2～50μg/min）去甲肾上腺素治疗.比较两组治疗前后血流动力学、NF-κB和IκB-α的变化.结果 治疗前两组心率及血流动力学指标[对照组：心率（116.5±11.8）次/min,平均动脉压（MAP）（47.2±6.4）mmHg,中心静脉压（CVP）（3.6±0.5）mmHg;研究组：心率（115.3±12.1）次/min,MAP（46.9±6.8mmHg）,CVP（5.1±1.6）mmHg]差异均无统计学意义（t=1.529、1.036、1.229,P=0.861、0.102、0.935）;治疗后研究组心率[（86.5±9.8）次/min]显著低于对照组[（99.4±10.5）次/min]（t=11.852,P=0.031）,同时CVP[（82.3±6.9）mmHg]、MAP[（5.9±1.8）mmHg]显著高于对照组[（75.1±5.9）mmHg,（5.1±1.6）mmHg]（t=12.943、13.058,P=0.038、0.019）.治疗前两组肾功能差异均无统计学意义（t=1.382、1.951,P=0.061、0.075）,治疗后研究组肌酐（Cr）以及尿素氮（BUN）显著高于对照组（t=16.082、15.943,P=0.021、0.023）.治疗前两组NF-κB和IκB-α 差异均无统计学意义（t=1.482、1.503,P=0.081、0.092）,治疗后研究组NF-κB以及IκB-α 表达显著低于对照组（t=10.639、11.835,均P〈0.05）.结论 感染性休克患者应用大剂量去甲肾上腺素治疗的效果理想,有利于改善患者生理指标以及NF-κB、IκB-α.

Objective To investigate the effect of high dose norepinephrine on hemodynamics, nuclear transcription factor κB （NF - κB） and human nuclear factor kappa B inhibitor protein alpha（IκB - α） in patients with septic shock. Methods From January 2016 to January 2017,50 patients with septic shock in Taizhou Central Hospital were selected and randomly divided into two groups according to the digital table,with 25 cases in each group. The control group was given small dose（1 - 30μg/ min） norepinephrine,and the study group was given large dose（2 - 50μg/ min） norepinephrine. The hemodynamics,expression of NF - κB and IκB - α before and after treat-ment were compared between the two groups. Results Before treatment,there were no statistically significant differ-ences in heart and hemodynamics between the two groups[control group： heart rate （116. 5 ± 11. 8）beats/ min,MAP （47. 2 ± 6. 4） mmHg,CVP（3. 6 ± 0. 5） mmHg;study group： heart rate （115. 3 ± 12. 1） beats/ min,MAP（46. 9 ± 6. 8mmHg）,CVP（5. 1 ± 1. 6）mmHg,t = 1. 529,1. 036,1. 229,P = 0. 861,0. 102,0. 935]. After treatment,the heart rate of the study group[（86. 5 ± 9. 8） beats/ min] was significantly lower than that of the control group[（99. 4 ± 10. 5）beats/ min]（t = 11. 852,P = 0. 031）,and CVP[（82. 3 ± 6. 9）mmHg],MAP[（5. 9 ± 1. 8）mmHg]of the study group were significantly higher than those of the control group[（75. 1 ± 5. 9） mmHg,（5. 1 ± 1. 6） mmHg] （ t =12. 943,13. 058,P = 0. 038,0. 019）. The renal function of the two groups had no statistically significant differences before treatment （t = 1. 382,1. 951,P = 0. 061,0. 075）. After treatment,the Cr and BUN of the study group were significantly higher than those of the control group（ t = 16. 082,15. 943,P = 0. 021,0. 023）. The expression of NF - κB and IκB - α of the two groups had no statistically significant differences before treatment （t = 1. 482,1. 503, P = 0. 081,0. 092）. After treatment,the expression of NF - κB and IκB - α of the study group were significantly lower than those of the control group （ t = 10. 639,11. 835, all P 〈 0. 05）. Conclusion The effect of high - dose norepinephrine in the treatment of patients with septic shock is ideal,which is beneficial to improve the physiological indicators and NF - κB,IκB - α.