不同液体早期复苏对感染性休克患者预后及脑钠肽水平的影响

摘要

Objective To study the effect of different fluids on early fluid resuscitation for brain natriuretic peptide (BNP) and prognosis in patients with septic shock, as a reference for clinical treatment. Method 82 patients with septic shock were randomly divided into four groups according to the fluids used in resuscitation: physiological saline resuscitation group (group A), 4% hypertonic saline resuscitation group (group B), hydroxyethyl starch resuscitation group (group C) and hypertonic sodium chloride hydroxyethyl starch 40 injection group (group D). EGDT standard rate, mortality, change of plasma BNP and APACHE Ⅱscores were compared among the four groups. Result There was no significant difference in the standard rate of EGDT and recovery rate among the four groups in 6 hours after resuscitation (P > 0.05). Ringer-locke liquor of group A was the most, but there was no significant difference compared with the other three groups (P > 0.05). There was significant difference in the study liquid and total recovery liquid in A, B, C, D groups (P < 0.05). The level of BNP was decreased after resuscitation, 6 hours after recovery treatment, the levels of BNP in the four groups were significantly different among the four groups; 6 and 72 hours after recovery treatment, the differences among the four groups in the serum levels of BNP were statistically significant (P < 0.05). 72 hours after treatment, the APACHE Ⅱ scores of the four groups were declined, group C and group D were decreased significantly (P < 0.05). 72 hours after treatment, the APACHE Ⅱ scores of group D were lower than group A and group B (P < 0.05), and the 28 days fatality rate was lower than group A, B,C (P < 0.05). Conclusion Hydroxyethyl starch 40 injection can improve the hemodynamic, maintain lower total resuscitation volume, decrease serum BNP level and improve the prognosis of patients with septic shock.%目的：探讨不同液体早期复苏对感染性休克患者预后及脑钠肽水平的影响，为临床治疗提供参考。方法将82例感染性休克患者随机分为四组，A 组患者使用0.9%生理盐水复苏，B 组患者使用4%高渗盐水复苏，C 组患者使用羟乙基淀粉复苏，D 组患者使用高渗氯化钠羟乙基淀粉40注射液复苏。观察记录四组患者早期目标导向治疗（EGDT）达标率、病死率、血浆脑钠肽水平变化、急性生理学及慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分。结果四组患者复苏后6小时内 EGDT 达标率和康复率比较差异均无显著性（P ＞0.05）。A 组患者林格液用量最多，但与其他三组比较无显著差异（P ＞0.05）；四组患者研究液体用量和复苏液体总量总体比较差异具有显著性（P ＜0.05）。复苏后血浆脑钠肽水平呈下降趋势，复苏治疗6小时后四组患者血浆脑钠肽水平总体比较具有显著差异（P ＜0.05）；复苏后6小时和72小时，D 组患者血浆脑钠肽水平明显低于其他三组（P ＜0.05）。四组患者复苏后72小时 APACHE Ⅱ评分较复苏前均有所下降，其中 C、D 两组下降较明显（P ＜0.05）；D 组患者复苏后72小时 APACHE Ⅱ评分明显低于 A、B 组（P ＜0.05），且28天病死率明显低于 A、B、C 组（P ＜0.05）。结论羟乙基淀粉40注射液复苏可明显改善感染性休克患者血流状态且保持较少复苏液体用量，并可降低患者血浆脑钠肽水平，明显改善预后。