多巴胺联合去甲肾上腺素对感染性休克患者血清降钙素原及肌钙蛋白1的影响

摘要

目的：观察多巴胺联合去甲肾上腺素对感染性休克患者血清降钙素原及肌钙蛋白1（ cTn1）的影响。方法选择2014年2月—2016年2月武汉市第七医院综合内科重症监护病房所收治的感染性休克患者100例作为研究对象，采用随机数字表法分为观察组和对照组各50例。对照组仅给予多巴胺治疗，观察组在对照组的基础上加用去甲肾上腺素。比较2组治疗后临床疗效，观察2组患者治疗前后血压、血浆氨基末端脑钠肽前体（ NT－proBNP）、左室射血分数（ LVEF）、血清降钙素原（ PCT）、cTn1、血清C反应蛋白（ CRP）、肿瘤坏死因子（ TNF－α）水平的变化，记录治疗中的不良反应。结果治疗后，观察组总有效率显著高于对照组（80．0％vs．62．0％，χ2＝3．933， P ＝0．047）；观察组舒张压、LVEF显著高于对照组[（67．83±7．45）mmHg vs．（62．05±6．93）mmHg，（59．84±8．30）％vs．（43．94±6．01）％， t ＝4．016、10．971， P均＜0．01]，NT－proBNP显著低于对照组[（1084．34±213．93）ng／L vs．（1458．29±275．83） ng／L， t ＝7．575， P ＜0．01]；PCT、cTn1、CRP、TNF－α水平均显著低于对照组[（0．95±0．14）μg／L vs．（2．63±0．47）μg／L，（1．74±0．25）μg／L vs．（3．09±0．51）μg／L，（5．12±0．79） mg／L vs．（6．95±1．14） mg／L，（75．32±18．93）ng／L vs．（146．87±23．16）ng／L， t ＝24．223、16．806、9．329、16．914， P均＜0．05]；不良反应发生率低于对照组（14．0％vs．32．0％，χ2＝4．573， P ＝0．032）。结论感染性休克患者给予多巴胺联合去甲肾上腺素治疗，效果显著，值得应用推广。%Objective To observe the effect of dopamine combined with norepinephrine on serum levels of procalcito-nin and troponin I (cTn1) in patients with septic shock.Methods One hundred cases of patients with septic shock were ad-mitted from February 2014 to February 2016 in department of general medicine, Seventh hospital of Wuhan, they were divided into observation group and control group by randomly, 50 cases in each group.The control group was treated with simple dopa-mine, and the observation group was treated with the addition of noradrenaline on the basis of the control group.The changes of blood pressure, NT-proBNP(N terminal B type natriuretic peptide), LVEF(left ventricular ejection fraction), serum levels of PCT ( procalcitonin) , cTn1 ( cardiac troponinⅠ) , CRP ( C reactive protein) , TNF-α( tumor necrosis factor α) were ob-served before and after treatment in two groups, and adverse reactions in the course of treatment were observed.Results After treatment, the total efficiency of the observation group was significantly higher than the control group (80.0% vs.62.0%,χ2 =3.933, P =0.047); LVEF, diastolic blood pressure was significantly higher than that of control group [(67.83 ± 7.45) mmHg vs.(62.05 ±6.93) mmHg, (59.84 ±8.30)%vs.(43.94 ±6.01)%, t =4.016, t =10.971, P <0.01], NT-proBNP was significantly lower than the control group [(1 084.34 ±213.93) ng/L vs.(1 458.29 ±275.83) ng/L, t =7.575, P <0.01];PCT, cTn1, CRP, TNF-αlevels were significantly lower than the control group [(0.95 ±0.14) μg/L vs.(2.63 ±0.47) g/L, (1.74 ±0.25) μg/L vs.(3.09 ±0.51) μg/L, (5.12 ±0.79) mg/L vs.(6.95 ±1.14) mg/L, (75.32 ±18.93) ng/L vs.(146.87 ±23.16) ng/L, t =24.223, t =16.806, t =9.329, t =16.914, P <0.05];adverse reaction the rate is lower than the control group (14 .0%vs.32.0%,χ2 =4.573, P =0.032).Conclusion Septic shock patients were treated with dopamine combined with norepinephrine, the effect is significant, it is worthy of application and pro-motion.