垂体后叶素治疗合并脓毒性休克的急性呼吸窘迫综合征的临床研究

Clinical study of pituitrin treatment on patients with ARDS combined with septic shock

目的探讨联合使用垂体后叶素对合并脓毒性休克的急性呼吸窘迫综合征(ARDS)患者的血流动力学、氧合指数及预后的影响。方法选取2013年06月到2016年12月南通市第三人民医院重症医学科收治的合并脓毒性休克的ARDS患者63例,随机分为常规治疗组30例和垂体后叶素治疗组33例,均在我科接受ARDS常规治疗和液体复苏治疗。记录患者的一般资料及疾病危重度评分,入科时、治疗24h、72h时的心率(HR)、平均动脉压(MAP)、相应的去甲肾上腺素(NE)用量及液体平衡,并记录上述三个时间点的血肌酐(Scr)、血乳酸(Lac)和氧合指数(Pa O_2/Fi O_2)。主要研究终点为28d病死率,次要研究终点为机械通气时间和ICU住院时间。结果与对照组比较,垂体后叶素组治疗24h时HR减慢,NE用量减少,P<0.05;治疗72h时,垂体后叶素组HR减慢,氧合改善,NE用量减少,液体负平衡增多,P<0.05。垂体后叶素组的机械通气时间、ICU住院时间均为28d,病死率均小于常规治疗组,但无统计学差异,P>0.05。结论对于合并脓毒性休克的ARDS患者,与单纯使用去甲肾上腺素相比,联合使用小剂量垂体后叶素可以减慢心率,减少NE的用量,减轻液体过负荷,改善氧合,具有较好的临床应用价值。

Objective To investigate the effect of pituitrin on hemodynamics,oxygenation index and prognosis in patients with acute respiratory distress syndrome(ARDS)complicated with septic shock.Methods A prospective randomized controlled trial was conducted.63 patients with ARDS combined with septic shock admitted to Intensive Care Unit of the Third hospital of Nantong city from June 1,2013 to December 31,2016 were enrolled,receiving the regular ARDS therapy and fluid resuscitation.The patients were randomized into the conventional treatment group(n=30)and the pituitrin treatment group(n=33).We recorded the general condition and the scores including APACHEⅡand SOFA,besides,the differences in heart rate(HR),mean arterial pressure(MAP),usage of norepinephrine,lactic acid(Lac),serum creatinine(SCr)and oxygenation index(PaO 2/FiO 2)were compared between the two groups at different time points of treatment.The primary endpoint was 28-day mortality,and the secondary endpoints were mechanical ventilation and ICU stay.Results There was no significant difference in the baseline characteristics.After 24 hours,the HR and norepinephrine dosage were significantly lower in the pituitrin treatment group than the conventional treatment group(P<0.05).After 72 hours,the HR and norepinephrine dosage were also lower in the pituitrin treatment group(P<0.05),and the oxygenation index and the negative fluid volume balance were significantly higher in the pituitrin treatment group(P<0.05).The 28-day mortality,mechanical ventilation and ICU stay of the pituitrin treatment group were lower,but there was no statistically significant difference.Conclusion The combined injection with pituitrin to patients with ARDS complicated with septic shock can decrease heart rate,reduce the dosage of norepinephrine and excessive fluid load,and improve the oxygenation index,which has better clinical application value.