艾司洛尔与米力农联用对感染性休克患者血乳酸清除率及碱剩余水平影响的相关分析

doi:10.3877/cma.j.issn.1674-1358.2017.05.008

目的

探讨Esmolol与Milinone联合用药治疗感染性休克的临床疗效。

方法

选择本院2010年2月至2015年10月收治的102例感染性休克患者，随机分为两组，其中治疗组63例，对照组39例；对两组患者的血乳酸清除率和碱剩余等血清学指标进行比较。

结果

两组患者平均动脉压、心指数、体循环阻力指数及中心静脉压在治疗期间差异均无统计学意义，治疗过程中治疗组和对照组患者血乳酸浓度均逐渐下降，但治疗组患者下降程度更为显著（t = 2.41，P = 0.02）；治疗组患者治疗后每个时间段乳酸清除率均显著高于对照组（P均< 0.05）。

结论

感染性休克患者往往出现明显的动脉血乳酸水平上升、碱剩余下降等代谢性酸中毒状态，Esmolol与Milinone联合用药能够在一定程度上缓解上述状态。动脉血乳酸清除率和碱剩作为血清学指标对该类患者的预后的判断有参考意义。

关键词: 艾司洛尔, 米力农, 血乳酸, 碱剩余

Objective

To investigate the clinical efficacy of Esmolol combined with Milinone in the treatment of septic shock.

Methods

Total of 102 cases of septic shock treated in our hospital from February 2010 to October 2015 were collected and randomly divided into two groups as treatment group (63 cases) and control group (39 cases). The evaluation criteria of blood lactate clearance rates and alkaline residual index were compared, respectively.

Results

Mean arterial pressure, cardiac index, systemic vascular resistance index and central venous pressure had no significant differences in the two groups of patients during treatment. However, blood lactate concentrations were gradually decreased in the treatment group and the control group, and the treatment group decreased more significantly in treatment group (t = 2.41, P = 0.02). Moreover, the lactate clearance rates in the treatment group of each time period after treatment were significantly higher than the control group (all P < 0.05).

Conclusions

The patients with septic shock often have significant metabolic acidosis such as elevated arterial blood lactate levels and alkaline residual decrease, and Esmolol plus Milinone could alleviate these conditions to some extent. The arterial lactate clearance rate and the residual alkali as serological indicators are of prognostic significance.

Key words: Esmolol, Milinone, Blood lactate, Alkali residual

表1 两组患者入院期间血流动力学指标变化（ ± s）

组别		例数	心率（次/min）	平均动脉压（mmHg）	心指数[L·min^-1·（m²）^-1]
治疗组		63
	0 h		138.6 ± 23.4	72.1 ± 11.2	2.6 ± 0.7
	2 h		111.2 ± 15.6	67.4 ± 14.2	2.6 ± 0.5
	3 h		105.3 ± 12.0	72.3 ± 15.1	3.1 ± 0.6
	4 h		104.1 ± 11.2	72.6 ± 12.7	2.4 ± 0.3
对照组		39
	0 h		132.3 ± 12.3	71.2 ± 13.4	2.2 ± 0.1
	2 h		131.2 ± 14.2	71.2 ± 13.1	2.6 ± 0.2
	3 h		130.1 ± 12.6	71.2 ± 11.0	2.7 ± 0.4
	4 h		131.5 ± 12.3	71.2 ± 11.2	2.3 ± 0.6
组别		例数	每搏指数（ml/m²）	体循环阻力指数[kPa·s/（L·m²）]	中心静脉压（mmHg）
治疗组		63
	0 h		16.2 ± 4.8	216.5 ± 83.1	16.5 ± 4.2
	2 h		30.2 ± 7.6	211.2 ± 74.2	11.9 ± 4.2
	3 h		33.2 ± 11.1	190.7 ± 71.8	11.3 ± 3.6
	4 h		31.9 ± 10.2	191.4 ± 72.8	13.5 ± 2.6
对照组		39
	0 h		15.1 ± 2.2	221.3 ± 80.5	17.1 ± 5.8
	2 h		15.1 ± 3.7	208.1 ± 61.2	16.1 ± 6.1
	3 h		17.4 ± 3.1	211.1 ± 59.1	12.2 ± 3.1
	4 h		18.2 ± 3.1	202.7 ± 52.7	12.4 ± 5.6

表1 两组患者入院期间血流动力学指标变化（ ± s）

组别		例数	心率（次/min）	平均动脉压（mmHg）	心指数[L·min^-1·（m²）^-1]
治疗组		63
	0 h		138.6 ± 23.4	72.1 ± 11.2	2.6 ± 0.7
	2 h		111.2 ± 15.6	67.4 ± 14.2	2.6 ± 0.5
	3 h		105.3 ± 12.0	72.3 ± 15.1	3.1 ± 0.6
	4 h		104.1 ± 11.2	72.6 ± 12.7	2.4 ± 0.3
对照组		39
	0 h		132.3 ± 12.3	71.2 ± 13.4	2.2 ± 0.1
	2 h		131.2 ± 14.2	71.2 ± 13.1	2.6 ± 0.2
	3 h		130.1 ± 12.6	71.2 ± 11.0	2.7 ± 0.4
	4 h		131.5 ± 12.3	71.2 ± 11.2	2.3 ± 0.6
组别		例数	每搏指数（ml/m²）	体循环阻力指数[kPa·s/（L·m²）]	中心静脉压（mmHg）
治疗组		63
	0 h		16.2 ± 4.8	216.5 ± 83.1	16.5 ± 4.2
	2 h		30.2 ± 7.6	211.2 ± 74.2	11.9 ± 4.2
	3 h		33.2 ± 11.1	190.7 ± 71.8	11.3 ± 3.6
	4 h		31.9 ± 10.2	191.4 ± 72.8	13.5 ± 2.6
对照组		39
	0 h		15.1 ± 2.2	221.3 ± 80.5	17.1 ± 5.8
	2 h		15.1 ± 3.7	208.1 ± 61.2	16.1 ± 6.1
	3 h		17.4 ± 3.1	211.1 ± 59.1	12.2 ± 3.1
	4 h		18.2 ± 3.1	202.7 ± 52.7	12.4 ± 5.6

表2 两组患者入院期间血气分析结果（ ± s）

组别		例数	血乳酸浓度（mmol/L）	乳酸清除率（%）	碱剩余（mmol/L）
治疗组		63
	0 h		5.56 ± 1.03	—	-11.21 ± 0.58
	6 h		3.99 ± 0.67	31.64 ± 2.11	-5.12 ± 0.53
	12 h		2.36 ± 0.53	37.45 ± 2.81	-1.08 ± 0.42
	24 h		1.42 ± 0.29	40.14 ± 3.12	1.31 ± 0.32
	48 h		1.22 ± 0.38	26.22 ± 2.745	4.01 ± 0.22
对照组		39
	0 h		7.16 ± 1.66	—	-14.21 ± 1.01
	6 h		6.45 ± 1.28	5.12 ± 1.22	-12.37 ± 1.14
	12 h		6.56 ± 1.12	8.36 ± 1.28	-9.76 ± 0.87
	24 h		5.88 ± 0.67	7.64 ± 1.36	-9.24 ± 0.28
	48 h		6.11 ± 0.87	-1.79 ± 0.59	-11.32 ± 0.63

表2 两组患者入院期间血气分析结果（ ± s）

组别		例数	血乳酸浓度（mmol/L）	乳酸清除率（%）	碱剩余（mmol/L）
治疗组		63
	0 h		5.56 ± 1.03	—	-11.21 ± 0.58
	6 h		3.99 ± 0.67	31.64 ± 2.11	-5.12 ± 0.53
	12 h		2.36 ± 0.53	37.45 ± 2.81	-1.08 ± 0.42
	24 h		1.42 ± 0.29	40.14 ± 3.12	1.31 ± 0.32
	48 h		1.22 ± 0.38	26.22 ± 2.745	4.01 ± 0.22
对照组		39
	0 h		7.16 ± 1.66	—	-14.21 ± 1.01
	6 h		6.45 ± 1.28	5.12 ± 1.22	-12.37 ± 1.14
	12 h		6.56 ± 1.12	8.36 ± 1.28	-9.76 ± 0.87
	24 h		5.88 ± 0.67	7.64 ± 1.36	-9.24 ± 0.28
	48 h		6.11 ± 0.87	-1.79 ± 0.59	-11.32 ± 0.63

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Correlation of Esmolol combined with Milinone on blood lactate clearance and residual alkaline level in patients with septic shock

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Correlation of Esmolol combined with Milinone on blood lactate clearance and residual alkaline level in patients with septic shock