外科手术后全身性炎性反应综合征和严重脓毒症患者血浆血管加压素浓度及其相关因素分析

目的：研究外科手术后全身性炎性反应综合征（SIRS）、严重脓毒症患者血浆血管加压素（AVP）浓度的变化,及其与动脉血气、血电解质、血流动力学参数的关系。方法：将2009年3月—2010年3月间收入外科监护病房（SICU）的患者,依据收入SICU24h内临床过程分为对照组、SIRS组、严重脓毒症组3组,每组10例。分别记录各组人口统计学资料、临床信息,测定动脉血气,入SICU24h内血浆AVP浓度及相应的血流动力学指标、中心静脉压、血生物化学检查数据。结果：严重脓毒症组患者的血浆AVP浓度显著高于对照组和SIRS组（1 300.59±87.49pg.mL-1比266.33±12.03pg.mL-1,397.59±18.32pg.mL-1）（P〈0.001）。血浆AVP浓度与对照组患者血Na＋值、Ca2＋值呈正相关（r=0.742,P=0.014;r=0.821,P=0.004）,仅与SIRS组患者血Na＋值呈正相关（r=0.727,P=0.017）,而与严重脓毒症组患者血Na＋值、Ca2＋值无相关（r=0.409,P=0.241）。血浆AVP浓度与严重脓毒症组患者平均动脉压（MAP）呈正相关（r=0.544,P=0.015）,与心率（HR）呈负相关（r=-0.706,P=0.023）,而与对照组及SIRS组患者的MAP及HR均无相关性（r=0.363,P=0.302;r=0.454,P=0.188）。结论：对照组与SIRS组患者血浆AVP浓度变化与血Na＋变化相关,而在严重脓毒症患者中AVP浓度仅与MAP相关,提示血流动力学的不稳定刺激了血浆AVP的分泌而发挥升压作用。

Plasma Vasopressin Concentration in Patients with Systemic Inflammatory Response Syndrome or Severe Sepsis and Correlation of The Clinical Settings

Objective：To compare the clinical course of vasopressin（AVP） plasma concentrations among patients undergone operations with non-infection,systemic inflammatory response syndrome（SIRS） and severe sepsis.Methods： There were 10 patients in the control group,SIRS group and severe sepsis group,respectively,of surgical intensive care unit from March 2009 to March 2010.All the patients were assigned based on their clinical course during the first 24 hours in surgical intensive care unit（SICU）.Hemodynamic,laboratory and clinical data were recorded within 24 hours after SICU admission while blood was collected to determine plasma AVP.Results： The AVP response was different between sever sepsis group and control group,SIRS group（1300.59±87.49 pg·mL-1 vs.266.33±12.03 pg·mL-1,397.59±18.32 pg·mL-1;P0.001）.Plasma AVP concentration correlated significantly with arterial blood values of Na＋ in control group（r=0.742,P=0.014） and SIRS group（r=0.727,P=0.017）,arterial blood values of Ca2＋ in control group（r=0.821,P=0.004）,mean arterial pressure（MAP）（r=0.544,P=0.015） and heart rate（HR）（r=-0.706,P=0.023） in severe sepsis group.Conclusions： Our results indicate that the AVP system does not function normally in severe sepsis and the patients with severe sepsis show a maintained relationship between AVP plasma levels and MAP.Our data support the hypothesis that the hemodynamic instability stimulates the release of AVP to raise blood pressure.