重症肺炎伴感染性休克行早期限制性液体复苏的治疗分析

Analysis of Early Restriction Liquid Recovery Treatment of Severe Pneumonia With Infectious Shock

目的分析重症肺炎伴感染性休克患者应用早期限制性液体复苏治疗对其凝血功能及降钙素原(procalcitonin,PCT)、血清可溶性髓系细胞表达触发受体-1(soluble triggering receptor expressed on myeloid cell-1,sTREM-1)水平的影响。方法选择2019年8月—2021年3月呼吸科和重症医学科收治的重症肺炎合并感染性休克患者,共120例。按随机数字表法分为对照组和观察组,对照组接受常规液体复苏治疗,观察组在对照组的基础上给予早期限制性液体复苏治疗,比较两组休克期恢复时间以及治疗前后的心输出量(cardiac output,CO)、血乳酸水平(blood lactic acid,BLA)、凝血功能、血清降钙素原(PCT)和可溶性髓样细胞触发受体-1(sTREM-1)水平,观察两组不良反应发生情况。结果观察组患者休克期恢复时间明显少于对照组,治疗后观察组CO高于对照组,BLA低于对照组,凝血酶原时间(prothrombin time,PT)和活化部分凝血活酶时间(activated partial thromboplastin time,APTT)高于对照组,纤维蛋白原(fibrinogen,FIB)和凝血酶时间(thrombin time,TT)低于对照组,且PCT、sTREM-1水平明显低于对照组,差异有统计学意义(P<0.05);观察组不良反应发生率显著低于对照组,差异有统计学意义(P<0.05)。结论早期限制性液体复苏能有效地降低大量液体输入造成的不良影响,改善凝血功能,降低血清PCT和sTREM-1水平,具有临床应用价值。

Objective To analyze the effect of early restrictive fluid resuscitation on coagulation function,procalcitonin(PCT)and soluble triggering receptor expressed on myeloid cell-1(sTREM-1)levels in patients with severe pneumonia and septic shock.Methods A total of 120 patients with severe pneumonia complicated by septic shock who were admitted to the department of respiratory medicine and the department of critical care medicine from August 2019 to March 2021 were selected.According to the random number table method,they were divided into the control group and the observation group.The control group was received routine fluid resuscitation,while the observation group was given early restrictive fluid resuscitation on the basis of the control group.Compared the recovery time during shock,the cardiac output(CO)before and after treatment,blood lactic acid(BLA),coagulation function,procalcitonin(PCT)and soluble triggering receptor expressed on myeloid cell-1(sTREM-1)levels.Observed the occurrence of adverse reactions in the two groups.Results The recovery time in the shock phase of the observation group was significantly shorter than that of the control group.After treatment,the CO in the observation group was higher than that in the control group,BLA was lower than that in the control group,prothrombin time(PT)and activated partial thromboplastin time(APTT)was higher than that of the control group,fibrinogen(FIB)and thrombin time(TT)were lower than those of the control group,and the levels of PCT and sTREM-1 were significantly lower than those of the control group,with statistically significant differences(P<0.05);the incidence of adverse reactions in the observation group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Early restrictive fluid resuscitation can effectively reduce the adverse effects caused by a large amount of fluid input,improve coagulation function,and reduce serum PCT and sTREM-1 levels,which has clinical application value.