前列地尔对脓毒性休克患者复苏达标后血流动力学指标的疗效观察

目的观察前列地尔对脓毒性休克患者复苏达标后血流动力学指标及预后的影响。 方法选择2016年9月至2018年9月就诊于兰州大学第一医院东岗院区重症医学科的80例脓毒性休克患者，待患者按早期目标导向治疗（EGDT）复苏达标后，将80例患者分为治疗组和对照组，每组各40例。所有患者进行抗感染、机械通气、器官功能维护及营养代谢等一般治疗，治疗组在此基础上静脉滴注前列地尔脂微球注射液，对照组则静脉滴注等渗NaCl溶液，均连续应用14 d。记录两组患者的一般资料，治疗前及治疗1、2、7 d后的急性病生理学和长期健康评价（APACHE）Ⅱ评分、序贯器官衰竭估计（SOFA）评分、平均动脉压、心率、中心静脉压、血乳酸、pH值、中心静脉血氧饱和度（ScvO₂）等血流动力学指标以及住院病死率，28 d病死率，ICU住院时间及总住院时间。 结果治疗组与对照组患者治疗前及治疗1、2、7 d后APACHEⅡ评分、SOFA评分、平均动脉压、心率、中心静脉压、血乳酸、pH值及ScvO₂水平比较，差异均有统计学意义（F = 11.661、8.689、11.005、12.006、9.045、10.217、11.065、6.031，P = 0.026、0.043、0.009、0.023、0.037、0.045、0.041、0.044）。进一步两两比较发现，治疗组患者治疗2、7 d后APACHEⅡ评分、SOFA评分、心率、中心静脉压及血乳酸水平均较对照组同时间点显著降低（P均< 0.05），治疗1、2、7 d后平均动脉压及治疗2、7 d后pH值和ScvO₂水平均较对照组同时间点显著升高（P均< 0.05）。治疗组患者的住院病死率20.0%（8/40）vs. 35.0%（14/40），χ² = 53.333，P<0.001]、28 d病死率25.0%（10/40）vs. 40.0%（16/40），χ² = 48.000，P < 0.001]、ICU住院时间（6.7 ± 2.2）d vs.（12.2 ± 2.5）d，t = 2.831，P = 0.047]及总住院时间（14.4 ± 3.6）d vs.（25.2 ± 4.9）d，t = 3.007，P = 0.037]均较对照组显著降低。 结论前列地尔可有效改善脓毒性休克患者的血流动力学指标及预后。

Therapeutic effect of alprostadil on hemodynamic parameters in patients with septic shock after resuscitation

ObjectiveTo observe the effects of alprostadil on the hemodynamic indices and prognosis of patients with septic shock. MethodsBetween September 2016 and September 2018, 80 patients with septic shock were selected from the Department of Critical Care Medicine, Donggang Branch of First Hospital of Lanzhou University. All patients were divided into a treatment group (n= 40) and a control group (n= 40) after they reached the standard of resuscitation according to the early goal-directed therapy (EGDT). All patients were treated with general treatment such as anti-infection, mechanical ventilation, organ function maintenance and nutrition metabolism. On this basis, patients in the treatment group were injected intravenously with alprostadil microspheres injection, and those in the control group were treated intravenously with isoosmotic NaCl solution, all for 14 consecutive days. The general data, hemodynamic indices such as acute physiology and chronic health evaluation (APACHE)Ⅱ score, sequential organ failure assessment (SOFA) score, mean arterial pressure, heart rate, central venous pressure, blood lactic acid, pH value and central venous oxygen saturation (ScvO₂) before and 1, 2, 7 d after treatment, inpatient mortality, 28-d mortality, ICU stay and total hospital stay were recorded in these two groups. ResultsThere were significant differences in APACHEⅡ score, SOFA score, mean arterial pressure, heart rate, central venous pressure, blood lactic acid, pH value and ScvO₂ before and 1, 2, 7 d after treatment between the treatment group and control group (F = 11.661, 8.689, 11.005, 12.006, 9.045, 10.217, 11.065, 6.031; P = 0.026, 0.043, 0.009, 0.023, 0.037, 0.045, 0.041, 0.044). Further pairwise comparison revealed that the APACHEⅡ score, SOFA score, heart rate, central venous pressure and blood lactic acid at 2, 7 d after treatment in the treatment group were significantly lower than those in the control group at the same time point (all P < 0.05). The mean arterial pressure at 1, 2, 7 d after treatment, pH value and ScvO₂ at 2, 7 d after treatment in the treatment group were significantly higher than those in the control group at the same time point (all P < 0.05). The inpatient mortality 20.0% (8/40) vs. 35.0% (14/40), χ² = 53.333, P < 0.001], 28-d mortality 25.0% (10/40) vs. 40.0% (16/40), χ² = 48.000, P < 0.001], ICU stay (6.7 ± 2.2) d vs. (12.2 ± 2.5) d, t = 2.831, P = 0.047], and total hospital stay (14.4 ± 3.6) d vs. (25.2 ± 4.9) d, t = 3.007, P = 0.037] in the treatment group were significantly lower than those in the control group. ConclusionAlprostadil can effectively improve hemodynamic parameters and prognosis of patients with septic shock.