液体复苏对重症脓毒症患者黏附分子及血流动力学的作用

目的 探讨液体复苏对重症脓毒症患者黏附分子及血流动力学的影响。方法 将38例重症脓毒症患者随机分为快速液体复苏组和常规补液速度组。记录液体复苏时间、液体用量以及阿拉明用量监测液体复苏前后：①血流动力学指标，包括心率、平均动脉压、中心静脉压；②组织灌注指标，如血乳酸水平；③黏附分子指标，包括血浆P-选择素及细胞间黏附分子-1浓度。结果 两组患者性别、年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分差异均无显著性。常规补液速度组复苏时间与快速液体复苏组比较差异无显著性；与常规补液速度组比较，快速液体复苏组液体用量较多，阿拉明用量较少（P均＜0．05）；与常规补液速度组比较，快速液体复苏组复苏后患者的平均动脉压及中心静脉压均增高，心率、血乳酸、血浆P-选择素及细胞间黏附分子-1浓度均降低（P均＜0．05），且较复苏前均有所改善。结论 重症脓毒症患者尽早进行液体复苏可改善其内皮细胞功能，抑制黏附分子的表达，其机制可能与液体复苏改善血流动力学状态、改善组织灌注有关。

Effect of fluid resuscitation on adhesion molecule and hemodynamics in patients with severe sepsis

OBJECTIVE: To explore the effects of fluid resuscitation on adhesion molecule and hemodynamics in patients with severe sepsis. METHODS: Thirty-eight patients with severe sepsis were randomly divided into 2 groups: rapid fluid resuscitation group and general treatment group. Before and after fluid resuscitation, heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), lactic acid content, plasma P-selection and intercellular adhesion molecule-1 (ICAM-1) contents were determined. RESULTS: There were no statistically significant differences in sex, age, resuscitation time and acute physiology and chronic health evaluation II (APACHE II) score between the two groups. Compared with general treatment group, more liquid volume but less aramine dosage were used (both P<0.05), MAP and CVP were increased after fluid resuscitation in rapid fluid resuscitation group (all P<0.05). The expression of P-selection, HR, contents of ICAM-1 and lactic acid were decreased (all P<0.05), and all of those were better than those of before fluid resuscitation. CONCLUSION: Early rapid fluid resuscitation can improve hemodynamics and decrease the expression of adhesion molecule to retard the development of sepsis.