特利加压素和去甲肾上腺素对感染性休克患者的早期应用研究

Early aApplication of Terlipressin and Nnorepinephrine in Patients with Sseptic Sshock

目的:探讨小剂量特利加压素联合去甲肾上腺素对感染性休克患者血流动力学和组织灌注的影响。方法:采用前瞻随机对照研究方法收集广西壮族自治区民族医院重症医学科收治的感染性休克患者,随机分为对照组和试验组,分别给予去甲肾上腺素(NE组)和小剂量特利加压素联合去甲肾上腺素(TP组)治疗维持目标血压,比较用药前(T0)和用药后12 h、24 h、36 h、48 h的PiCCO(脉搏指示连续心排血量技术)检测相关指标及患者血乳酸、肌酐情况。结果:本研究共入选82例感染性休克患者,NE组39例,TP组43例,两组的一般资料和基线资料比较无明显统计学差异。NE组和TP组两组患者进行比较显示,组内比较中两组的CI、ScvO2、SVRI、GEDI、EVLWI在各个时间点的差异无统计学意义(P>0.05)。血乳酸和肌酐在第0 h、12 h、24 h、36 h、48 h时间点的比较有统计学差异,两组均呈下降趋势。NE组血清中乳酸的含量较TP组下降明显(P<0.05)。结论:特利加压素与去甲肾上腺素均有助于改善感染性休克患者的血流动力学状况,提高乳酸清除率,小剂量特利加压素联合去甲肾上腺素更有效改善肾功能。

Objective:To investigate the effects of low dose of Teripressin plus norepinephrine on hemodynamics and tissue perfusion in patients with septic shock.Methods:The patients with septic shock from the Department of ICU of Ethnic Hospital of Guangxi Zhuang autonomous region were prospective randomized controlled investigated.Patients were divided them into control group and trial group.noradrenaline(NE group)and small doses of Teripressin combined with norepinephrine(TP group)treatment to maintain target blood pressure.The relevant indicators and the patient′s blood lactic acid and creatinine status of PiCCO(pulse indication continuous cardiac drainage)before(T0)and after 12 h,24 h,36 h,and 48 h were compared.Results:82 patients with septic shock,39 in the NEA group and 43 in the TP group were selected for this study.There was no significant statistical difference in general data and baseline data between groups.Comparison of the two groups of patients in the NETP group showed that there wasere no statistically significant differences between the two groups in CI,ScvO2,SVRI,GEDI,and EVLWI at each time point in the group,(P>0.05).The comparison of serum lLactic acid and creatinine at points 0h,12h,24h,36h,and 48h showed statistical differences in each groups(P<0.05),and both groups showed a declining trend.CI,ScvO2,SVRI,GEDI,EVLWI,and creatinine did not have statistical significance between the two groups.The level of lactic acid in the serum of the NE group was significantly lower than that of the TP group(P<0.05).Conclusion:Teripressin Teri plus epinephrine and norepinephrine can improved the hemodynamics of patients with septic shock,improvefastened the removal rate of lactic acid.,and lLower dose of TeripressinTeri plus norepinephrine can improved renal function more effectively.