血管紧张素Ⅱ受体拮抗剂对脓毒症患者血流动力学的影响

Effects of angiotensinⅡreceptor blockers on hemodynamics in patients with sepsis

目的:研究服用血管紧张素Ⅱ受体拮抗剂(angiotensinⅡreceptor blockers,ARBs)对脓毒症患者血流动力学的影响。方法:回顾性分析2016年1月至2018年12月南通大学附属医院重症医学科收治的脓毒症患者的病历资料。将脓毒症确诊前连续服用ARBs超过1个月的患者设为ARBs组,未服用ARBs的患者设为对照组。比较两组患者的一般资料、血流动力学指标、重症监护病房(intensive care unit,ICU)平均住院时间、28 d病死率的差异。结果:两组患者的年龄、性别、体质量指数(body mass index,BMI)、基础血压(收缩压/舒张压)、入院急性生理与慢性健康评分(acute physiology,age,chronic health evaluationⅡ,APACHEⅡ)、序贯器官功能障碍评分(sequential organ failure assessment,SOFA)差异无统计学意义。两组患者0 h的平均动脉压、心脏指数、体循环阻力指数、胸腔内总血容量、全心舒张末期容积指数差异无统计学意义。ARBs组0 h(P=0.03)和24 h(P=0.04)的乳酸水平低于对照组,差异有统计学意义。ARBs组24 h的平均动脉压高于对照组(P=0.04),而24 h全心舒张末期容积指数低于对照组(P=0.03),差异有统计学意义。ARBs组和对照组患者的ICU平均住院时间差异无统计学意义[(20.8±3.4)vs(22.6±2.2)d,P=0.14]。ARBs组和对照组的28 d病死率差异无统计学意义(32.8%vs 40.1%,P=0.09)。结论:服用ARBs的脓毒症患者血流动力学更早恢复稳定,不增加ICU平均住院时间和28 d病死率。

Objective:To study the effects of angiotensinⅡreceptor blockers(ARBs)on hemodynamics in patients with sepsis.Methods:A retrospective analysis was made on the medical records of the patients with sepsis admitted into the intensive care unit(ICU)of the Affiliated Hospital of Nantong University from January 2016 to December 2018.The patients who had taken ARBs for more than one month before diagnosis of sepsis were designated as the ARBs group and those who had not taken ARBs were assigned as the control group.The differences in general medical data,hemodynamic indexes,length of stay in ICU and the 28-day mortality rate were compared between the two groups.Results:There was no statistical significance in age,gender,body mass index(BMI),basic blood pressure(systolic/diastolic blood pressure)data,acute physiology,age,chronic health evaluationⅡ(APACHEⅡ)scores at admission and sequential organ failure assessment(SOFA)scores,when comparisons were made between the two groups.Significant differences could neither be seen in mean arterial pressure,cardiac index,systemic circulation resistance index,total blood volume in thoracic cavity and end diastolic volume index at 0 h,when comparisons were made between the two groups.In the ARBs group,the lactic acid levels at 0 h(P=0.03)and at 24 h(P=0.04)were significantly lower than those in the control group,with statistical significance.The mean arterial pressure at 24 h(P=0.04)in the ARBs group was significantly higher than that in the control group,while global end-diastolic volume index at 24 h(P=0.03)was significantly lower than that in the control group,also with statistical significance.The average length of stay in ICU for the ARBs group and the control group was respectively(20.8±3.4)and(22.6±2.2)d,without statistical significance(P=0.14).No statistical significance could be noticed in the 28-day mortality rate for the ARBs and control groups(32.8%vs 40.1%,P=0.09).Conclusion:The recovery of hemodynamics in the patients with sepsis treated with ARBs was relatively earlier,but the average length of stay in ICU and the 28-day mortality rate were not increased.