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硝酸甘油对感染性休克合并ARDS患者的临床疗效观察
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硝酸甘油对感染性休克合并ARDS患者的临床疗效观察
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Journal Article
硝酸甘油对感染性休克合并ARDS患者的临床疗效观察
2015
Overview
目的评价硝酸甘油对感染性休克合并急性呼吸窘迫综合征（ARDS）患者的临床疗效,并探讨其可能的作用机制。方法纳入2013年1月-2014年1月兰州大学第一医院重症医学科收治的感染性休克合并ARDS患者,将符合标准者随机分为对照组和硝酸甘油组。对照组给予标准治疗,硝酸甘油组在标准治疗基础上,给予硝酸甘油0.5~1.0mg/h静脉泵入。入组后0、6、24、72h记录两组各项监测指标,包括一般情况、APACHEⅡ评分、血流动力学指标、呼吸功能监测指标、呼吸机使用时间、ICU停留时间、住院及28d病死率、免疫指标（CD4＋/CD8＋）及炎症指标等。结果共43位患者入选,其中对照组21例,硝酸甘油组22例。在治疗24、72h时点两组患者APACHEⅡ评分、心率、肺动脉压（PAP）、乳酸及多巴胺、去甲肾上腺素、呼吸频率（RR）、吸入氧浓度（Fi O2）、气道阻力、C反应蛋白（CRP）、降钙素原（PCT）、白介素-6（IL-6）、白细胞（WBC）均较入组时及治疗6h时下降,且72h时硝酸甘油组明显低于对照组（P〈0.05）;同时,外周血管阻力指数（SVRI）、p H值、动脉氧分压（Pa O2）、潮气量（VT）、肺顺应性、氧合指数、CD4＋/CD8＋在治疗24h、72h时较入组时及6h时明显升高,且72h时硝酸甘油组明显高于对照组（P〈0.05）。硝酸甘油组机械通气（MV）时间为4.3±0.6d,明显低于对照组（6.1±0.7d,P〈0.05）;ICU住院时间及总住院时间分别为7.8±0.8d、9.3±0.6d,明显低于对照组（分别为9.2±0.9d、12.9±1.3d,P〈0.05）;住院病死率及28d病死率均明显低于对照组（P〈0.05）。结论对感染性休克合并ARDS患者使用硝酸甘油可以使呼吸机条件改善,降低机械通气、ICU停留及总住院时间,降低病死率。这可能与硝酸甘油可改善微循环,降低肺循环阻力及全身炎性反应,提高免疫力有关。
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