摘要
目的探讨在脓毒性休克患者初始复苏中早期应用去甲肾上腺素的临床价值。方法将2023年1月至2023年12月入住滨州市中心医院的脓毒性休克的78例患者为研究对象,随机分为对照组(40例)和观察组(38例)。初始复苏时对照组常规留取相关病原学培养、应用广谱抗菌药物、补液、测乳酸等措施;观察组早期应用去甲肾上腺素,其它措施同对照组。比较两组患者在初始复苏后3、6 h的心率(heart rate,HR)、中心静脉压(central venous pressure,CVP)、中心静脉血氧饱和度(central venous oxygen saturation,Scvo 2)、平均动脉压(mean arterial pressure,MAP)、血乳酸浓度(blood lactate concentration,Lac)、乳酸清除率(lactate clearance rate,LCR)、毛细血管充盈时间(capillary filling time,CRT)、液体入量(mL/kg)及复苏有效率。结果初始复苏3 h后,观察组CRT、液体入量低于对照组,CVP、Scvo 2、MAP高于对照组(P<0.05);HR、Lac、LCR与对照组比较,差异没有统计学意义。复苏6 h后观察组HR、CRT、液体入量、Lac低于对照组,CVP、Scvo2、MAP、LCR高于对照组(P<0.05)。独立样本卡方检验显示观察组复苏有效率为86.8%(33/38),对照组有效率为65.0%(26/40)(P=0.025)。结论早期应用去甲肾上腺素更适合于脓毒性休克患者的初始复苏;同时可减少复苏液体入量。
Objective To Explore the clinical value of early application of norepinephrine in initial resuscitation of patients with septic shock.Methods Seventy-eight patients with septic shock admitted to Binzhou Central Hospital from January 2023 to December 2023 were selected as the study subjects and randomly divided into a control group(40 cases)and an observation group(38 cases)using a random number table method.During initial recovery,the control group was subjected to routine measures such as collecting relevant pathogen cultures,applying broad-spectrum antibiotics,fluid replacement,and lactate testing;The observation group will apply norepinephrine early,and other measures will be the same as the control group.Compare the heart rate(HR),central venous pressure(CVP),central venous oxygen saturation(Scvo 2),mean arterial pressure(MAP),blood lactate concentration(Lac),lactate clearance rate(LCR),capillary filling time(CRT),fluid intake(mL/kg),and resuscitation efficacy between two groups of patients at 3 and 6 hours after initial resuscitation.Results After 3 hours of initial resuscitation,the observation group had lower capillary filling time(CRT)and fluid intake than the control group,while the central venous pressure(CVP),central venous oxygen saturation(Scvo 2),and mean arterial pressure(MAP)were higher than the control group,with statistically significant differences(P<0.05);After 6 hours of resuscitation,the heart rate(HR),capillary filling time(CRT),fluid intake,and blood lactate concentration(Lac)in the observation group were lower than those in the control group,while the central venous pressure(CVP),central venous oxygen saturation(Scvo 2),mean arterial pressure(MAP),and lactate clearance rate(LCR)were higher than those in the control group,with statistical significance(P<0.05).The independent sample chi square test showed that the effective rate of recovery in the observation group was 86.8%(33/38),and the effective rate in the control group was 65.0%(26/40),with a statistically significant difference(P=0.025).Conclusions Early application of norepinephrine is more suitable for the initial resuscitation of patients with septic shock;At the same time,it can reduce the amount of resuscitation fluid.
作者
张辉
郭文
张学苹
魏兴超
丁昊
尹睿
ZHANG Hui;GUO Wen;ZHANG Xueping;WEI Xingchao;DING Hao;YIN Rui(Department of Critical Care Medicine,Binzhou Central Hospital,Binzhou 251700,Shandong,P.R.China;Department of Critical Care Medicine,Binzhou People's Hospital,Binzhou 256610,Shandong,P.R.China)
出处
《滨州医学院学报》
2025年第4期389-392,共4页
Journal of Binzhou Medical University
