特利加压素对脓毒性休克患者心肺损伤组织灌注及氧代谢指标的影响

Effects of trivasopressin on cardiopulmonary injury tissue perfusion and oxygen metabolism indexes in the patients with septic shock

目的分析特利加压素对脓毒性休克患者心肺损伤、组织灌注及氧代谢指标的影响.方法所选120例脓毒性休克患者均为华中科技大学协和江北医院2017年3月至2019年3月收治,通过数字随机方法将其分成对照组与试验组(每组各60例);入院后两组患者均根据《成人脓毒性休克的血流动力学监测和支持指南》开展集束化治疗和早期监测,对照组给予去甲肾上腺素静脉持续泵入,试验组则给予去甲肾上腺素与特利加压素静脉持续泵入;观察分析患者的心肺损伤、组织灌注及氧代谢指标变化情况.结果与入组前比较,两组患者入组后96 h的氧合指数(oxygen index,OI)水平明显提高(P<0.05),肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,cTnI)、氨基末端B型利钠肽前体(N-terminal pro-brainnatriuretic peptide,NT-proBNP)水平则明显降低(P<0.05);而且入组后96 h试验组的CK-MB、cTnT、NT-proBNP水平明显低于对照组(t=2.524、4.719、9.031,P=0.013、0.001、0.001<0.05),OI水平明显高于对照组(t=5.666,P=0.000l).与入组前比较,两组入组后96 h的血乳酸(lactic acid,Lae)水平明显降低(P<0.05),中心静脉血氧饱和度(central venous oxygensaturation,ScvO2)、平均动脉压(average arterial pressure,MAP)、灌注指数(perfusion index,PI)水平明显提高(P<0.05);与对照组比较,试验组入组后96 h血Lac水平明显降低(P<0.05),而ScvO2、MAP及PI水平则明显上升(P<0.05).与对照组比较,试验组的机械通气时间、去甲肾上腺素使用时间、ICU住院时间均明显缩短(t=4.529、3.474、7.841,P=0.001、0.001、0.001),24h补液量明显减少(t=2.107,P=0.037).两组的临床病死率、不良反应发生率比较差异有统计学意义(P<0.05).结论选择特利加压素治疗脓毒性休克患者,能改善氧代谢障碍和组织低灌注,有效保护器官功能,明显缩短ICU住院时间和机械通气时间,值得临床推广.

Objective To analyze the effects of trivasopressin on cardiopulmonary injury,tissue perfusion and oxygen metabolism indexes in the patients with septic shock.Methods The 120 septic shock.patients selected in this study were all admitted to our hospital from March 2017 to March 2019.They were divided into control group and experimental group by digital random method,with 60 cases in each group.After admission,the two groups of patients were given intensive treatment and early monitoring according to the guidelines for hemodynamic monitoring and the supporl of adult septic shock.The control group was given continuous pumping of norepinephrine,while the experimental group was given continuous pumping of norepinephrine ami trivasopressin.The changes of cardiopulmonary injury,tissue perfusion and oxygen metalxdism were observed ami analyzed.Results Compared with liefore joining the group,in the two groups oxygen index(01)level significantly increased(P<0.05),creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnl),N-terminal pro-brain-natriuretic peptide(NT-proBNP)levels were significantly reduced(P<0.05)at 96 h after joining the group;Moreover,the levels of CK-MB,cTnl,NT-proBNP in the experimental group were significantly lower than those in the control group(l=2.524.4.719,9.031,P=0.013,0.001,0.001<0.05),and the levels of 01 were significantly higher than those in the control group(t=5.666.P=0.0001).After enrollment,lactic acid(Lac)level was significantly decreased(P<0.05),central venous oxygen saturation(ScvO2),average arterial pressure(MAP)and perfusion index(PI)levels were significantly increased(P<0.05).In addition,compared with the control group.Lac level of the experimental group was significantly decreased(P<0.05),while Scv02 and MAP.PI levels were significantly increased(P<0.05).Compared with the control group,mechanical ventilation time,norepinephrine use time ami ICC hospitalization time were significantly shortened in the experimental group(t=4.529,3.474,7.841.P=0.001,0.001,0.001),and the amount of rehydration at 24 h was significantly reduced(t=2.107.P-0.037).There were significant differences in clinical mortality and adverse reaction incidence between the two groups(P<0.05).Conclusion Treating septic shock patients with trivasopressin can achieve ideal results,improve oxygen metabolism disorder and tissue hypoperfusion,effectively protect organ function,and significantly shorten the length of hospital stay and mechanical ventilation time in ICU,which is worthy of clinical promotion.