Clinical study of dexmedetomidine in rescue of septic shock patients
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摘要: 目的 探讨右美托咪定在抢救脓毒症休克患者中的临床应用。 方法 选择2015年6月—2016年10月亳州市人民医院重症医学科收治的脓毒症休克患者20例纳入研究,随机分为右美托咪定组10例和对照组10例,全部患者均按治疗指南积极行EGDT液体复苏,右美托咪定组经静脉泵入右美托咪定[0.2~0.7μg/(kg·h)],心率(HR)控制在60~100次/min,对照组对心率不进行特别干预,观察目标:治疗前及治疗后24、48、72 h HR、平均动脉压(MAP)、每搏量指数(SVI)、中心静脉血氧饱和度(ScvO2)、血乳酸(Lac)的变化。 结果 右美托咪定组治疗后心率减慢,与治疗前比较差异有统计学意义(P<0.05),与对照组同期比较,差异亦有统计学意义(P<0.05);右美托咪定组治疗前后平均动脉压变化不明显,差异无统计学意义,与对照组同期比较,差异亦无统计学意义;右美托咪定组治疗24 h后ScvO2上升,48 h后SVI增加,与治疗前比较差异均有统计学意义(P<0.05),与对照组同期比较,差异亦均有统计学意义(P<0.05);右美托咪定组治疗48 h后乳酸与治疗前比较,差异有统计学意义(P<0.05),与对照组同期比较,差异亦有统计学意义(P<0.05)。 结论 右美托咪定组治疗后HR逐渐开始减慢,SVI、ScvO2逐渐升高,Lac逐渐降低,而MAP无明显改变。与对照组比较,右美托咪定组治疗24 h后HR明显减慢,ScvO2开始升高,48 h起SVI升高明显,Lac降低明显。右美托咪定通过抑制脓毒症休克患者交感神经活性,稳定血流动力学,可以改善机体组织氧代谢。Abstract: Objective To explore the clinical application of dexmedetomidine in the rescue of septic shock patients. Methods Twenty patients with septic shock admitted in intensive care unit (ICU) ward of Bozhou People's Hospital from June, 2015 to October, 2016 were included in the study. All patients were randomly divided into dexmedetomidine group 10 cases and control group 10 cases, All patients were treated with guideline and positive EGDT fluid recovery, In the dexmedetomidine group, intravenous infusion of dexmedetomidine 0. 2-0. 7 μg/(kg·h), heart rate control in the 60-100 beats/min, the control group on the heart rate is not particularly intervene in the control group. The changes of HR, MAP, stroke volume index (SVI), central venous oxygen saturation (ScvO2) and blood lactate (Lac) were measured before and 24, 48 and 72 h after treatment. Results Dexmedetomidine group after treatment slowed heart rate, There was significant difference (P < 0. 05) before and after treatment. at the same time compared with the control group, the difference was statistically significant (P < 0. 05). There was no significant difference in the mean arterial blood pressure between the two groups, and there was no significant difference before and after treatment in the dexmedetomidine group.Dexmedetomidine treatment 24 hours ScvO2 increased, 48 hours SVI increased, There was significant difference (P <0. 05) before and after treatment. at the same time compared with the control group, the difference was statistically significant (P < 0. 05). Dexmedetomidine treatment significantly decreased lactic acid after 48 hours, the difference was statistically significant (P < 0. 05) before and after treatment in the dexmedetomidine group, at the same time compared with the control group, the difference was statistically significant (P < 0. 05). Conclusion In the group of dexmedetomidine, the HR gradually began to slow down, SVI, ScvO2 gradually increased, Lac gradually decreased, while the MAP no significant change. Compared with the control group, dexmedetomidine treatment significantly reduced HR after 24 hours, ScvO2 began to rise, 48 h from the ScvO2 increased significantly, Lac decreased significantly. Dexmedetomidine can improve the oxygen metabolism of the organism by inhibiting sympathetic nerve activity and stabilizing hemodynamics in patients with septic shock.
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Key words:
- Dexmedetomidine /
- Septic shock /
- SVI /
- ScvO2 /
- Lac
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