感染性休克患者去甲肾上腺素应用时机

The Application Timing of Norepinephrine in Patients with Septic Shock

目的:探讨感染性休克患者早期应用去甲肾上腺素的治疗效果。方法:抽取86例感染性休克患者为研究对象。对患者资料进行回顾性分析,根据休克复苏方式不同将患者分为观察组44例和对照组42例。达到复苏目标前,观察组患者以晶体液快速扩容的同时持续泵入去甲肾上腺素;对照组初始仅以晶体液快速扩容,3h后如仍未达到复苏目标,也给予持续泵入去甲肾上腺素。比较两组血乳酸变化趋势、外周血管主力(SVRI)变化趋势、达到复苏目标时间、多器官功能障碍综合征(MODS)发生率、ICU住院时间及28d死亡率。结果:观察组MODS发生率、达到复苏目标时间及ICU住院时间均低于对照组,差异有统计学意义(P<0.05)。观察组早期复苏达标率高于对照组,差异有统计学意义(P<0.05)。经积极复苏治疗,两组乳酸均下降,但观察组下降较快,差异有统计学意义(P<0.05)。3h及6h观察组SVRI高于对照组,差异有统计学意义(P<0.05);12h两组SVRI差异无统计学意义(P>0.05)。28d死亡率两组差异无统计学意义(P>0.05)。结论:对于中重度感染性休克患者早期快速补液的同时联合应用血管活性药物是必要、安全、有效的。

Objective To assess the clinical effects of early administration of the norepinephrine in treatment of septic shock.Method Clinical data of 86 patients with septic shock were collected.According to different means of septic resuscitation,patients were divided into the observation group with 44 cases and the control group with 42 cases.Before achieving the resuscitation target,the patients of observation group were treated with rapid plasma volume expansion with crystalloid and continuously pumping of norepinephrine;the patients of control group were only treated with rapid plasma volume expansion with crystalloid,and if not achieved the resuscitation target after 3 hours,continuously pumping of norepinephrine was also given to these patients.Then compare a series of dates,including the in cidence of MODS,28-day mortality,the time achieving the resuscitation target and staying in ICU,changes of serum lactic (LAC) and SVRI.Results The incidence of complications,28-day mortality,the time achieving the resuscitation target and staying in ICU in observation group was less than those in control group,with significant difference .LAC was lower in the observation group than in the control group,the difference wa s statitically significant.Before 6 hours,the SVRI was higher in the observation group than in the control group,the difference was significant.There was no statistical difference in 28-day mortality between the two groups.Conclusion For patients with septic shock,rapid plasma volume expansion combined with earlier application of norepinephrine is necessary,safe and effective.