不同液体对感染性休克早期液体复苏的影响研究

目的 观察用不同复苏液体进行早期液体复苏后对感染性休克患者血压、血乳酸清除率和病死率的影响.方法 将60例感染性休克成人患者随机分为生理盐水复苏组(NS组)、羟乙基淀粉复苏组(HES组)、4%高渗盐水复苏组(4%NaCl组)、高渗氯化钠羟乙基淀粉40注射液组(霍姆液组),每组15例.分别经中心静脉通路输入相应复苏液体进行包括液体复苏在内的抗休克治疗.观察各组患者治疗后血流动力学指标、血乳酸清除率和病死率的变化.结果 4%NaCl组、霍姆液组研究液体量及复苏液体总量均显著少于NS组和HES组(P均＜0.01).复苏1 h,霍姆液组平均动脉压较其他3组明显提升(P均＜0.01);24 h血乳酸清除率也较其他3组为高(P均＜0.01)I而4组间严重感染相关器官功能衰竭评分(SOFA评分)、急性生理学与慢性健康状况评分系统I(APACHE I)评分及28 d病死率差异均无统计学意义(P均＞0.05),但可观察到霍姆液组28 d病死率有下降趋势.结论 在感染性休克的早期液体复苏中,尽快提升血压有改善血乳酸清除率的作用,使用霍姆液可在迅速提升血压的同时,保持较少的复苏液体总用量.

The effect of different fluids on early fluid resuscitation in septic shock

OBJECTIVE: To study the effects of different fluids on blood pressure (BP), blood lactate clearance and mortality in patients with septic shock after early fluid resuscitation. METHODS: Sixty patients were enrolled and randomly divided into four groups according to the fluids used in resuscitation: normal saline (NS) group (15 cases), hydroxyethyl starch (HES) group (15 cases), 4% hypertonic saline solution (4%NaCl) group (15 cases), hypertonic sodium chloride hydroxyethyl starch 40 solution (HSH40) group, (15 cases). Patients of different groups received fluid resuscitation via central vein, at the same time, received the anti-shock treatment. Hemodynamic parameters, blood lactate clearance and mortality in patients were monitored after resuscitation. RESULTS: The study fluid volume and the total fluid volume in the 4%NaCl group and HSH40 group was lower than that in NS group and HES group significantly (all P<0.01). The mean arterial pressure (MAP) in HSH40 group was significantly higher than in the other three groups 1 hour after the fluid resuscitation (all P<0.01). The 24-hour blood lactate clearance in HSH40 group was also higher than in the other three groups (all P<0.01). The scores of sepsis-related organ failure assessment (SOFA) scores, acute physiology and chronic health evaluation II (APACHEII) scores, and 28-day mortality showed no significant differences among these groups (all P>0.05), but a lowering trend on 28-day mortality could be observed in HSH40 group. CONCLUSION: The rapid elevation of BP can improve blood lactate clearance in patients with septic shock receiving early fluid resuscitation. Compared with other fluids, HSH40 raises BP more quickly and needs lower total resuscitation volume to achieve the same goal.