摘要
目的探讨感染性休克后期患者血管加压素(VP)分泌调节异常的规律及预后价值。方法选取2012年1月—2014年2月收治的感染性休克患者55例,测定其输注3%氯化钠溶液前后血钠及血清VP水平,以△VP/ANa≤0.5 pg/mmol为无反应组,>0.5 pg/mmol为有反应组,比较2组患者血乳酸、C反应蛋白水平,应用血管活性药物的差异以及28 d病死率、(死亡患者)生存时间、(存活患者)住ICU时间。结果无反应组30例(54.5%),有反应组25例(45.5%)。2组患者性别、年龄、.APACHE Il评分、中心静脉压(CVP)、血压、血浆白蛋白水平、输注高渗盐水前后血钠水平差异均无统计学意义(分别为x^2=0.267,t=-0..563,-0.596,-0.712,0.779,1.306,0.257,0.233,均P>0.05),输注高渗盐水前后VP水平(ng/L)无反应组均低于有反应组(10.66±1.57 vs.17.13±5.12,t=6.091,P<0.01;11.65±1.74 vs.22.50±5.31,t=9.758,P<0.01)。无反应组的血乳酸、C反应蛋白水平及应用多巴胺或去甲肾上腺素剂量均高于有反应组(分别为t=-5.881,-4.143,-5.725,-5.62.5,P均<0.01)。28 d病死率无反应组高于有反应组(66.7%vs.40.0%,x^2=3.911,P<0.05);(死亡患者)生存时间2组无差异[(5.8±1.9)d vs.(6.1±2.3)d,t=0.384,P=0.704];(存活患者)住ICU时间无反应组高于有反应组[(9.9±2.3)d vs.(6.7±1.7)d,t=-4.044,P<0.01]。结论感染性休克后期患者基于渗透压调节的VP分泌障碍有较高的发生率,对评价患者预后有一定价值。
Objective To investigate the abnormal regular pattern and prognostic value of vascular vasopressin（VP）secretion in patients with late infection shock.Methods From 2012 January to 2014 February,55 patients with septic shock were enrolled,serum sodium and serum level of VP,Delta VP/ Delta Na were measured before and after the infusion of 3%Sodium Chloride Solution,△VP/△Na less than or equal to 0.5 pg/mmol were defined as non-response group,△VP/△Na 0.5 pg/mmol were definded as response group,levels of blood lactic acid,C reactive protein,differences in drug application of vasoactive and 28 d mortality rate,survival time of death patients,ICU stay time of survivors were compared between the 2groups.Results Non-response group has 30 cases（54.5%）,response group has 25 cases（45.5%）.2 groups of patients＇ gender,age,APACHE II score,central venous pressure（CVP）,blood pressure,plasma albumin level revealed no differences（t =-0.563,t =-0.596,t =-0.712,t =0.779,t =1.306,P 0.05）,the differences in the level of serum sodium transport before and after injection of hypertonic saline had no statistical significance（t=0.267,t=0.257,t=0.233,P 0.05）,VP transmission level before and after the injection of hypertonic saline（ng/L） in the non-response group were lower than those of response group（10.66 ±1.57 vs.17.13 ±5.12,t=6.091,P 0.01;11.65 ± 1.74,vs.22.50 ±5.31,t =9.758,P 0.01）.Blood lactic acid,C reactive protein level and the dose of dopamine or norepinephrine in the Non-response group were higher than those of response group（t =-5.881,t=-4.143,t=-5.725,t=-5.625,respectively,P 0.01）.28 day＇ s mortality of non-response group was higher than that of response group（66.7%vs.40.0%,X^2 =3.911,P0.05）;（death patients） survival time revealed no significant difference between the 2 groups,（5.8 ±1.9）d vs.（6.1 ±2.3） d,t=0.384,P =0.704;（survivors） ICU stay time in the non-response group was higher than that of response group[（9.9±2.3） d vs.（6.7 ±1.7） d,t =-4.044
出处
《疑难病杂志》
CAS
2014年第12期1247-1250,共4页
Chinese Journal of Difficult and Complicated Cases
基金
河北省医学科学研究重点课题计划(No.20110319)
关键词
血管加压素
休克
感染性
预后
渗透压
Vasopressin
Shock
septic
Prognostic
Osmotic pressure
