特利加压素联合去甲肾上腺素治疗真菌性肺炎所致感染性休克的疗效

Clinical efficacy comparison of NE with terlipressin in the treatment of septic shock induced bysevere aspergillus pneumonia

目的探讨特利加压素联合去甲肾上腺素(NE)与去甲肾上腺素治疗真菌性肺炎引起的感染性休克临床疗效差异,为后续治疗方案选择提供参考。方法选取濮阳市油田总医院2017年2月至2019年2月收治的重症真菌性肺炎引起的感染性休克患者共70例,以随机抽签法分为对照组(35例)和观察组(35例),在卡泊芬净基础上分别给予NE和特利加压素联合NE方案治疗,比较2组患者24 h血乳酸清除率和血乳酸水平,治疗前后血流动力学指标水平、炎性因子水平及48 h内NE用量。结果治疗后观察组24 h血乳酸清除率、血乳酸水平、心率(HR)、有创平均动脉压(MAP)及中心静脉压(CVP)水平分别为69.75%±8.32%,(2.18±0.41)mmol/L,(92.10±4.02)次,(68.77±5.50)mm Hg,(11.47±2.40)mm Hg,均显著优于对照组的46.10%±6.19%,(3.42±0.70)mmol/L,(104.82±5.38)次,(63.31±4.43)mm Hg,(9.60±1.83)mm Hg(P<0.05);观察组治疗后CRP、TNF-α及PCT水平分别为(5.49±1.03)mg/L,(89.62±11.35)mg/L,(0.97±0.15)μg/L,均显著低于对照组的(8.30±1.45)mg/L,(131.25±19.63)mg/L,(2.05±0.32)μg/L(P<0.05);同时观察组48 h内NE用量为(0.40±0.07)μg·kg-1·min-1,少于对照组的(0.63±0.10)μg·kg-1·min-1(P<0.05)。结论特利加压素联合NE治疗重症真菌性肺炎引起的感染性休克疗效确切,且NE用量降低,未加重心脏负荷。

Objective To investigate the clinical efficacy differences of norepinephrine(NE)combined with terlipressin and NE used alone in the treatment of septic shock induced by severe aspergillus pneumonia patients. Methods Totally 70 septic shock patients induced by severe aspergillus pneumonia were chosen from February 2017 to February 2019 in Puyang Oilfield General Hospital and randomly divided into control group(35 patients)with NE and observation group(35 patients)with NE combined with terlipressin on the basis of caspofungin;and the 24 h lactate clearance rate and lactate levels,the levels of hemodynamic index,inflammatory factor,and NE dosage within 48 h before and after treatment in the 2 groups were compared. Results The 24 h lactate clearance rate,24 h lactate levels,heart rate(HR),mean arterial pressure(MAP)and central venous pressure(CVP) of observation group after treatment was 69. 75%±8. 32%,(2. 18±0. 41) mmol/L,(92. 10±4. 02)times,(68. 77±5. 50)mmHg,(11. 47±2. 40)mmHg,which was significantly better than control group of 46. 10%±6. 19%,(3. 42±0. 70)mmol/L,(104. 82±5. 38)times,(63. 31±4. 43)mm Hg,(9. 60±1. 83)mm Hg,respectively(P<0. 05). The levels of CRP,TNF-α and PCT of observation group after treatment was(5. 49±1. 03)mg/L,(89. 62±11. 35)mg/L,(0. 97±0. 15)μg/L,which was significantly less than control group of(8. 30±1. 45)mg/L,(131. 25±19. 63)mg/L,(2. 05±0. 32)μg/L,respectively(P<0. 05). The NE dosage within 48 h of observation group was(0. 40±0. 07)μg·kg-1·min-1,significantly less than(0. 63±0. 10)μg·kg-1·min-1 in control group(P<0. 05). Conclusion NE combined with terlipressin on the basis of caspofungin in the treatment of septic shock patients with severe aspergillus pneumonia can efficiently increase lactate clearance effect,improve HR and CVP,reduce inflammation level,increase NE dosage,and not increase cardiac load.