左西孟旦对重症脓毒症患者组织氧耗及灌注影响的临床研究

摘要

Objective To observe the effect of levosimendan on oxygen consumption and tissue perfusion for severe sepsis. Methods 30 cases of severe sepsis patients admitted to the surgical ICU department during 2012.1~2013.4 were included, with serum Lac level>4mmol/L and ScvO2<70% after EGDT. they were randomly divided into control group (n=15) and treatment group (n=15). The treatment group was received regular treatments plus dobutamine and levosimendan. Invasive artery and central venous catheter were placed and monitored continously. blood gas analysis were performed at 6h, 12h, 24h, 48h and 72h after inclusion. ICU stay, ICU mortality rate were recorded, as well as the adverse event like malignant arrhythmia and severe hypotention. Results There is no signiifcant difference in the common charateristics between two groups before treatment (P>0.05),as well as the CVP and MBP value at mulitiple time-points after treament(P>0.05). The Lac level decreased in both groups, with much lower content in the treatment group compared with control group(P<0.05).Tthe ScvO2 increased in both groups, and it raised more signiifcantly in the treatment group compared with control group(P<0.05). there was signiifcant difference in the ICU stay, ICU mortality rate between two groups(P<0.05). 6 cases occurred obvious arrhythmia in control group, with none in treatment group. Conclusion It was approved by levosimendan for oxygen consumption and tissue perfusion for severe sepsis patients and no signiifcant adverse reactions.%目的：观察左西孟旦针对重症脓毒症患者组织氧耗及灌注的影响。方法病例来源于2012年1月至2013年4月间我院外科ICU的年龄在18～60岁之间的重症脓毒症患者，早期目标复苏后血乳酸（Lac）＞4mmol/L和中心静脉血氧饱和度（SCVO2）＜70%的患者共30例。随机分为对照组和试验组，各15例，常规治疗基础上分别加用多巴酚丁胺针、左西孟旦针。所有患者均行持续有创动脉及中心静脉监测。比较两组一般情况。入组第6、12、24、48、72h行中心静脉血气分析。记录ICU住院时间、ICU病死率。记录恶性心律失常、严重低血压等不良反应。结果治疗前一般情况比较无显著性差异（P＞0.05）。治疗后多个时间点CVP及MBP组间比较无显著性差异（P＞0.05）。两组患者Lac均呈下降趋势，与对照组比较，试验组下降明显（P＜0.05）。两组患者SCVO2有升高趋势，与对照组比较，试验组明显升高（P＜0.05）。对照组和试验组的ICU住院天数和ICU内病死率比较差异显著（P＜0.05）。对照组中有6例出现明显心律失常，试验组中未见不良反应。结论左西孟旦可改善脓毒症患者的组织氧耗及灌注情况，且无明显不良反应。