摘要
目的观察左西孟旦对脓毒性休克患者肾脏功能保护作用。方法选取脓毒性休克32例,按照治疗方法不同将其分为观察组和对照组两组各16例。观察组先静脉滴注多巴酚丁胺24 h后,改用左西孟旦连续静脉滴注24 h;对照组持续静脉滴注多巴酚丁胺48 h。观察比较两组治疗前后血流动力学参数、左室射血分数(LVEF)、肾血流阻力指数(RI)、血乳酸、血肌酐清除率、尿胰岛素样生长因子结合蛋白7(IGFBP-7)、尿金属蛋白酶组织抑制剂2(TIMP-2)、其他相关指标,以及治疗期间不良反应发生情况。结果治疗前,两组血流动力学参数、LVEF、肾血流RI、血乳酸、血肌酐清除率及尿IGFBP-7、TIMP-2比较差异均无统计学意义(P>0.05)。治疗后,两组心率(HR)和中心静脉压(CVP)均较治疗前降低;观察组LVEF和血肌酐清除率较治疗前升高,肾血流RI和血乳酸、尿IGFBP-7、TIMP-2较治疗前降低,差异有统计学意义(P<0.05或P<0.01)。治疗后,观察组HR、CVP、肾血流RI、血乳酸及尿IGFBP-7、TIMP-2低于对照组,LVEF及血肌酐清除率高于对照组,差异有统计学意义(P<0.05或P<0.01)。观察组非连续性肾脏替代治疗患者24 h尿量多于对照组,差异有统计学意义(P<0.05)。治疗期间,两组均未出现相关不良反应。结论左西孟旦治疗脓毒性休克患者可以改善肾血流RI,增加肾脏叶间动脉血流,改善肾脏灌注,对肾脏功能有保护作用。
Objective To evaluate the protective effect of Levosimendan on renal function in patients with septic shock. Methods Thirty-two patients with septic shock were enrolled and divided into levosimendan group(n=16) and dobutamine group(n=16) according to different therapies. The levosimendan group received a 24 h infusion of dobutamine followed by a 24 h infusion of levosimendan, while the dobutamine group received intravenous injection of dobutamine for 48 h. The hemodynamic parameters, left ventricular ejection fraction(LVEF), renal blood flow resistance index(RI), blood lactic acid, blood creatinine clearance, and urinary insulin-like growth factor binding protein 7(IGFBP-7), tissue inhibitor of metallo proteinase 2(TIMP-2), and other related indicators before and after treatment, and the occurrence of adverse reactions during treatment were observed and compared between the two groups. Results Before treatment, there were no significant differences in hemodynamic parameters, LVEF, RI, blood lactic acid, blood creatinine clearance, IGFBP-7 and TIMP-2 in the two groups(P>0.05). After treatment, the heart rate(HR) and central venous pressure(CVP) were significantly decreased. The LVEF and serum creatinine clearance of the levosimendan group were significantly higher, while RI and blood lactic acid, urine IGFBP-7, and urine TIMP-2 were significantly lower, as compared with those before treatment(P<0.05 or P<0.01). After treatment, the HR, CVP, RI, blood lactic acid, urine IGFBP-7, and urine TIMP-2 were significantly lower in the levosimendan group than in the dobutamine group, and the LVEF and creatinine clearance were significantly higher than those in the dobutamine group(P<0.05 or P<0.01). The 24 h urine volume in the levosimendan group was significantly more than that in the dobutamine group(P<0.05). During the treatment, no adverse reactions were found in both groups. Conclusion Levosimendan can ameliorate RI, improve blood flow in renal interlobar artery and increase the renal perfusion, thereby protecting renal function of patients with septic shock.
作者
卞晓华
刘莉
夏为
秦延军
BIAN Xiao-hua;LIU Li;XIA Wei;QIN Yan-jun(Department of Emergency,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Cardiology,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China;Department of Emergency,the 980th Hospital of PLA Joint Logisitics Support Forces,Shijiazhuang 050082,China)
出处
《临床误诊误治》
2020年第5期48-54,共7页
Clinical Misdiagnosis & Mistherapy
基金
河北省2019年度医学科学研究重点课题计划(20190604)。
