去甲肾上腺素联合磷酸肌酸钠对脓毒症休克早期急性肾损伤的影响

Effects of norepinephrine combined with creatine phosphate sodium on the early acute kidney injury of patients with septic shock

目的探讨去甲肾上腺素(NS)联合磷酸肌酸钠(CP)对脓毒症休克早期肾功能的保护作用。方法选择2016年5月至2017年5月急诊科收治的发病时间<24 h的脓毒症休克患者40例,随机分为NS组和NS+CP组,每组20例。观察患者0 h、 24 h、72 h患者射血分数(EF)、脑钠肽(BNP)、Marshall心脏评分(PAR值)、乳酸(Lac)、肌酐(Cr)清除率、尿量(UV)、肾小叶间动脉阻力指数(RI)变化;7 d内CRRT使用率;Cr清除率、UV和RI与Lac的相关性。结果与0 h相比,24 h NS组患者EF显著升高(P<0.01),乳酸、RAP显著降低(P<0.01),Cr清除率与UV未见明显变化(P>0.05);24 h与NS组相比,NS+CP组Lac、EF、PAR值未见明显异常(P>0.05),RI及Cr清除率显著下降(P<0.01),UV显著升高(P<0.01)。72 h与NS组相比,NS+CP组EF、UV升高显著(P<0.01),Lac、PAR值、Cr清除率、RI下降显著(P<0.01)。与NS组相比,NS+CP组7 d内CRRT使用率显著下降(P<0.05)。0 h Cr清除率和UV与Lac的相关性相比,RI升高显著(P<0.01)。结论磷酸肌酸钠可早期协同去甲肾上腺素保护脓毒症休克的肾功能,RI可用于脓毒症休克早期肾功能的评估。

Objective To investigate the protective effects of norepinephrine(NS) combined with creatinephosphatesodium(CP) on early renal function of patients with septic shock.Methods A total of 40 patients with septic shock(disease time <24 hours) who were admitted and treated in our hospital from May 2016 to May 2017 were enrolled in the study,who were randomly divided into NS group(n=20),NS + CP group(n=20). The changes of ejection fraction(EF),Marshall heart score(PAR);creatinine clearance(Cr),urine volume(UV),RI and lactate(Lac),Cr,UV,RI at 0 hour,24 hours,72 hours,and the utilization rate of CRRT within 7 days,Cr clearance were observed and compared between the two groups.Results As compared with that at 0 hour,the EF at 24 hours in NS group was increased significantly(P<0.01),and Lac and RAP were decreased significantly(P<0.01),but Cr clearance and UV had no obvious changes(P>0.05).As compared with those in NS group,the Lac,EF% and PAR had no obvious differences at 24 h in NS+CP group(P>0.05),while RI and Cr clearance were significantly decreased(P<0.01),and UV was significantly increased(P<0.01).As compared with those at 72 h in NS group,the EF% and UV were increased significantly in NS+CP group(P<0.01),however, Lac,PAR,Cr clearance and RI were decreased significantly(P<0.01).As compared with that in NS group,the utilization rate of CRRT in NS+CP group was decreased significantly within 7 days.In the aspect of correlation between Cr,UV and Lac,RI was increased significantly(P<0.01).Conclusion Creatinephosphatesodium combined with norepinephrine can protect the renal function of patients with septic shock,and RI can be used to evaluate the renal function of patients at early stage.