纳美芬治疗感染性休克的临床疗效观察

目的 观察纳美芬治疗感染性休克患者的疗效.方法 选择2008年12月至2009年6月本院重症监护病房(ICU)收治的感染性休克早期患者20例,按随机数字表法均分成治疗组和对照组.两组均按照2008年国际严重感染和感染性休克治疗指南的要求进行常规抗休克治疗;治疗组早期静脉推注纳美芬,而对照组给予等量生理盐水.观察两组患者血流动力学、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分及28 d病死率.结果 与对照组比较,治疗组治疗2、6、12、24 h时平均动脉压(MAP,mm Hg,1 mm Hg=0.133 kPa)明显升高(对照组:59.67±3.56、60.50±2.67、60.68±4.97、61.09±4.92,治疗组:65.83±5.76、70.83±5.76、83.63±5.87、82.85±8.36,均P＜0.05),心率(HR,次/min)明显下降(对照组:119.79±8.03、118.56±11.48、116.35±12.48、114.68±8.91,治疗组:103.33±10.87、92.29±12.55、90.49±17.29、86.66±11.53,均P＜0.05);治疗6、12、24 h时心排血指数(CI,L·min-1·m-2)明显升高(对照组:3.63±0.13、3.67±0.31、3.76±0.23,治疗组:4.01±0.45、4.22±0.39、4.45±0.32,均P＜0.05);治疗12 h、24 h时尿量(ml·kg-1·min-1)明显增多(对照组:0.53±0.39、0.51±0.40,治疗组:0.85±0.25、1.06±0.58,均P＜0.05),乳酸值(mmol/L)明显下降(对照组:5.54±3.98、4.91±2.98,治疗组:1.51±0.83、1.14±0.62,均P＜0.05).治疗组治疗24 h APACHE I评分(分)明显低于对照组(16.1±1.9比21.7±5.2,P＜0.05),但28 d病死率与对照组比较差异无统计学意义(20%比40%,P=0.629).结论 在常规抗休克治疗基础上早期应用纳美芬可以改善患者血流动力学,有利于抢救感染性休克,但对28 d病死率无明显影响.

Clinical observation of the effect of nalmefene in treatment of septic shock

Objective To study the effect of nalmefene in treatment of patients with septic shock.Methods Twenty patients, suffering from septic shock, admitted to the intensive care unit (ICU) from December, 2008 to June, 2009, were randomly divided into treatment group and control group.Following the international guidelines for management of severe sepsis and septic shock 2008 as the routine anti-shock therapy, nalmefene was administered early in the treatment group, while in the control group same amount of normal saline was given as a placebo.Hemodynamics, acute physiology and chronic health evaluation 1 (APACHE Ⅱ) score and 28-day mortality were observed in patients.Results Compared with control group,mean arterial pressure (MAP, mm Hg, 1 mm Hg=0.133 kPa) in treatment group was significantly higher at 2, 6, 12, 24 hours (control group: 59.67 ± 3.56, 60.50 ± 2.67, 60.68 ± 4.97, 61.09 ± 4.92 ;treatment group: 65.83±5.76, 70.83±5.76, 83.63±5.87, 82.85±8.36, all P＜0.05), while heart rate (HR, beat per min) decreased significantly (control group: 119.79±8.05, 118.56±11.48, 116.35±12.48, 114.68±8.91;treatment group: 103.33±10.87, 92.29±12.55, 90.49±17.29, 86.66±11.53, all P＜0.05).In treatment group, cardiac index (CI, L· min-1 · m-2) at 6, 12, 24 hours was significantly higher (control group: 3.63±0.13, 3.67±0.31, 3.76±0.23;treatment group: 4.01±0.45, 4.22±0.39, 4.45±0.32, all P ＜0.05).Compared with control group, urine output (ml·kg-1·min-1) in treatment group was significantly increased at 12 hours and 24 hours (control group: 0.53± 0.39, 0.51 ± 0.40;treatment group:0.85 ± 0.25, 1.06 ± 0.58, both P＜0.05), while lactic acid (mmol/L) decreased significantly (control group: 5.54 ± 3.98, 4.91±2.98;treatment group: 1.51±0.83, 1.14 ± 0.62, both P＜0.05).The APACHE Ⅱ score of the treatment group lowered significantly, and it was significantly lower than the control group at 24 hours (16.1±1.9 vs.21.7±5.2, P＜0.05).Compared between the two groups, the 28-day mortality showed no significant difference (20%vs.40%, P=0.629).Conclusion Based on the conventional anti-shock therapy, early use of nalmefene can improve the hemodynamics, which is conducive to ameliorate septic shock, however, there is no significant effect on 28-day mortality.