Han Xu-dong, Sun Hua, Huang Xiao-ying, Zhang Su-yan, Wang Ya-dong, Ren Ke, Li Feng
Third Hospital of Nantong City, Nantong, Jiangsu, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Jan;24(1):33-7.
To investigate whether pituitrin can lower 28-day mortality as compared with treatment with norepinephrine (NE) in patients with septic shock.
Randomized, controlled, open-label trial was conducted. One hundred and thirty-nine septic shock patients with dopamine requirements exceeding 5 μg×kg(-1)×min(-1) were divided at random into two groups as the study group and control group. All patients enrolled were treated by the same treatment principle and measures. In patients of study group injection of pituitrin 0.017-0.042 U/min (1.0- 2.5 U/h) was given, and if hemodynamics was still unstable, catecholamines was added to obtain the target blood pressure; while in the control group catecholamines was given to maintain stability of hemodynamics.
Among 139 patients enrolled in the study, 66 composed of the clinical study group and 73 in the control group. The main principle of the treatment in the two groups was similar. There was no significant difference in overall 28-day mortality rate between study group and control group (40.9% vs. 46.6%, P > 0.05). In patients whose acute physiology and chronic health evaluation II ( APACHE II ) score was less than 25, the mortality of study group was significantly lower than that of control group [10.3% (3/29) vs. 35.7% (10/28), P < 0.05]. The length of stay in intensive care unit [ICU, days: 5(3,8) vs. 5(3,8)], and duration of mechanical ventilation [days: 4.0 (2.8, 6.0) vs. 4.0 (2.0, 5.0)] were similar in two groups (both P > 0.05). The dosage of NE (μg/min: 7.99 ± 5.02 vs. 10.12 ± 5.12) and heart rate (beat/min: 93.27 ± 7.84 vs. 108.45 ± 12.31) were significantly lower in study group compared with that of control group (both P < 0.05). Serum creatinine and lactate levels in the two groups were similar at baseline, and creatinine [μmol/L: 87.5 (62.8, 157.0) vs. 76.0 (52.5, 117.0)] and lactate level (mmol/L: 3.72 ± 2.47 vs. 3.53 ± 1.86) were still similar in two groups 24 hours later (all P > 0.05). The rate of use of glucocorticoid (43.9% vs. 31.5%) and heparin in small dosage (42.4% vs. 41.1%) had no significant difference between two groups (both P > 0.05).
Combined use of pituitrin in patients with septic shock can reduce the dosage of catecholamines, and decrease the heart rate. Although it can not lower the overall mortality of septic shock, among patients with less severity whose APACHE II score lower than 25, low-dose pituitrin in conjunction with catecholamine vasopressors can reduce 28-day mortality .
探讨在感染性休克患者中，与去甲肾上腺素（NE）治疗相比，垂体后叶素是否能降低28天死亡率。
进行随机、对照、开放标签试验。139例多巴胺需求量超过5μg×kg⁻¹×min⁻¹的感染性休克患者随机分为研究组和对照组。所有纳入患者均采用相同的治疗原则和措施。研究组患者静脉注射垂体后叶素0.017 - 0.042U/min（1.0 - 2.5U/h），若血流动力学仍不稳定，则加用儿茶酚胺类药物以达到目标血压；而对照组给予儿茶酚胺类药物以维持血流动力学稳定。
在139例纳入研究的患者中，临床研究组66例，对照组73例。两组治疗的主要原则相似。研究组与对照组的总体28天死亡率无显著差异（40.9%对46.6%，P>0.05）。急性生理与慢性健康状况评分II（APACHE II）小于25分的患者中，研究组的死亡率显著低于对照组[10.3%（3/29）对35.7%（10/28），P<0.05]。两组在重症监护病房（ICU）的住院时间[天数：5（3，8）对5（3，8）]以及机械通气时间[天数：4.0（2.8，6.0）对4.0（2.0，5.0）]相似（均P>0.05）。研究组的NE用量（μg/min：7.99±5.02对10.12±5.12）和心率（次/分钟：93.27±7.84对108.45±12.31）均显著低于对照组（均P<0.05）。两组血清肌酐和乳酸水平在基线时相似，24小时后肌酐[μmol/L：87.5（62.8，157.0）对76.0（52.5，117.0）]和乳酸水平（mmol/L：3.72±2.47对3.53±1.86）仍相似（均P>0.05）。两组糖皮质激素使用率（43.9%对31.5%）和小剂量肝素使用率（42.4%对41.1%）无显著差异（均P>0.05）。
感染性休克患者联合使用垂体后叶素可减少儿茶酚胺类药物用量，并降低心率。虽然它不能降低感染性休克的总体死亡率，但在APACHE II评分低于25分、病情较轻的患者中，小剂量垂体后叶素联合儿茶酚胺类血管升压药可降低28天死亡率。
