PICCO指导下液体复苏对脓毒症休克患者血浆内皮素-1的影响

摘要

目的：探讨在脓毒症休克的早期液体复苏对血浆内皮素-1的影响。方法选择严重脓毒症休克患者46例根据治疗过程中，根据是否应用PICCO监测技术，分为PICCO组(25例)和常规组(21例)，对比分析两组按早期目标导向治疗的液体复苏过程中内皮素-1、氧合指数和血乳酸等指标水平在各时间点的变化情况。结果两组脓毒症休克患者性别、年龄、原发病、急性生理学慢性健康状况评分系统( APACHEⅡ)差异均无统计学意义( P<0．05)。在液体复苏开始时，两组血清ET-1、CK-MB、cTnI均处于较高水平，随时间推移，呈逐渐下降趋势；在对应时间点上PICCO组ET-1、CK-MB、cTnI、PaO2/FiO2、血乳酸水平明显低于常规组(P<0．05)。结论 PICCO指导下的液体复苏能较快下调脓毒症休克患者血浆内皮素-1水平。%Objective To investigate the effects of fluid resuscitation on the expression of endothelin-1 in patients with sepsis shock. Methods In a retrospective study, 46 patients who were diagnosed to be suffering from septic shock in the intensive care unit(ICU)were enrolled,from January 2012 to December 2013 and were divided into two groups:PICCO group(n=25)and the conventional group(n=21). We compared the level of ET-1,lactate and the oxygenation index in different time point. Results There were no significant difference between the two groups in sex,age,etiology of critical illness,medical history,APACHE II scores. In the beginning of fluid resuscitation,levels of serum ET-1, CK-MB, cTnI were at a high leveltwo serum ET-1, CK-MB, cTnI were at a high level. In the corresponding time points PICCO group ET-1, CK-MB, cTnI, PaO2/FiO2, blood lactate levels were significantly lower than the conventional group(P<0. 05). Conclusion PICCO under the guidance of fluid resuscitation in patients with septic shock can be quickly lowered plasma levels of endothelin-1.