摘要
目的探讨感染性休克后期患者血管加压素（VP）对渗透压升高的反应规律。方法以2012年1月至2013年9月河北医科大学第一医院重症监护病房（ICU）37例感染性休克患者为研究对象，测定其输注3％高渗氯化钠溶液前后血清vP及血钠水平。以输液前后VP和血钠差值的比值（△VP，△Na）≤0．5pg/mmol为无反应组，〉0．5pg/mmol为有反应组，比较两组患者年龄、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、血压、血浆白蛋白水平，及血管活性药物使用情况。结果无反应组20例（占54．05％），有反应组17例（占45．95％）无反应组基础VP水平显著低于有反应组（ng／L：10．41±1．70比18．25±5．90，t=5．29，P〈0．01），输注3％高渗氯化钠溶液后无反应组VP水平仍显著低于有反应组（ng/L：11．36±1．90比24．33±5．46，t=9．33，P〈0．01）。两组患者均应用多巴胺（DA）或去甲肾上腺素（NE），无反应组应用DA或NE的剂量均明显高于有反应组[DA（μg·kg^-1·min^-1）：14．91±3．78比8．64±1．69，t=-5．02，P〈0．01；NE（μg·kg^-1·min^-1）：1．03±0．48比0．38±0．12，t=-3．12，P〈0．01]。无反应组有3例联合应用血管活性药物（DA＋NE），而有反应组无联合用药者。两组患者年龄、APACHEⅡ评分、血压、血浆白蛋白水平、输注高渗氯化钠溶液前后血钠水平差异均无统计学意义。结论感染性休克后期患者VP对渗透压改变的调节能力受损，分泌功能下降，VP合成障碍。
Objective To investigate the vasopressin （VP） response to increasing osmotic pressure in the late-phase of septic shock patients. Methods Thirty-seven septic shock patients hospitalized in intensive care unit （ICU） of the First Hospital of Hebei Medical University from January 2012 to September 2013 were enrolled. All patients received 3% hypertonic saline solution infusion. Serum concentrations of VP and sodium were measured before and after hypertonic saline solution infusion. Patients with ratio of difference in VP and sodium before and after infusion of 3% hypertonic saline （AVP/ANa） ~〈0.5 pg/mmol were defined as nonresponders, and who 〉0.5 pg/mmol defined as responders. The age, acute physiological and chronic health evaluation II （APACHE II ） score, blood pressure, albumin level, vasoactive drug between the two groups were also analyzed. Results VP level in the nonresponsive group （n=20, 54.05%） was markedly lowered before （ng/L： 10.41±1.70 vs. 18.25 ±5.90, t=5.29, P〈0.01 ） and after （ng/L： 11.36 ± 1.90 vs. 24.33 ± 5.46, t=9.33, P〈0.01 ） 3% hypertonic saline solution infusion, compared with that in the responsive group （n =17, 45.95% ）. All patients in the two groups were given dopamine （DA） or norepinephrine （NE） for maintaining blood pressure, and the dose in the nonresponsive group were higher than those in the responsive group IDA （μg·kg^-1·min^-1） ： 14.91 ± 3.78 vs. 8.64 ± 1.69, t=-5.02, P〈0.01; NE （μg·kg^-1·min^-1）： 1.03 ± 0.48 vs. 0.38 ± 0.12, t=-3.12, P〈0.011. Three patients were given DA plus NE in the nonresponsive group while patients in the responsive group received only single drug therapy. The age, APACHE II score, blood pressure, albumin level, sodium level before and after hypertonic saline solution infusion between the two groups were not statistically different. Conclusion VP secretion to osmotic challenge was impaired and decreased in the late-phase of septic shock, prompting dysfunction in VP synthesis.
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2014年第1期33-35,共3页
Chinese Critical Care Medicine
基金
基金项目：河北省医药科研重点课题计划（20110319）
