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去甲肾上腺素联合磷酸肌酸钠对感染性休克患者心功能及预后的影响。

Effect of norepinephrine combined with sodium phosphocreatine on cardiac function and prognosis of patients with septic shock.

机构信息

Department of Emergency, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.

Department of Intensive Care, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.

出版信息

Int J Immunopathol Pharmacol. 2020 Jan-Dec;34:2058738420950583. doi: 10.1177/2058738420950583.

DOI:10.1177/2058738420950583
PMID:33206570
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7683914/
Abstract

Septic shock (SS) leads to a high mortality rate for sepsis patients. Norepinephrine (NE) is a preferred vasoactive agent in SS treatment. This study aimed to assess the effects of NE at different administration time and NE combined with SP treatment on the cardiac function and prognosis of SS.SS patients received NE treatment at different administration time and NE combined with SP treatment were enrolled in this study. The serum levels of cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP), ejection fraction (EF), and pressure-adjusted heart rate (PAR) value were analyzed to evaluate cardiac function. The 28-day survival information was collected and assessed using the Kaplan-Meier method and log-rank test.The cardiac function of SS patients was improved significantly by NE treatment, especially in the patients received NE at 2 h after fluid infusion, which evidenced by the increased BNP and cTnI levels and EF% and the decreased RAP. In the NE-2 h group, SS patients had a better 28-day survival rate compared with those patients in NE-1 h and -3 h groups. Furthermore, the significantly improved cardiac function and survival outcomes were found in patients received NE combined SP treatment.Taken together, this study results show that NE administration at 2 h after fluid infusion may be the optimal time point for the treatment of SS and NE combined with SP treatment can improve early cardiac dysfunction and 28-day survival outcomes in patients with SS.

摘要

脓毒性休克(SS)导致脓毒症患者的死亡率很高。去甲肾上腺素(NE)是 SS 治疗中首选的血管活性药物。本研究旨在评估不同给药时间的 NE 和 NE 联合 SP 治疗对 SS 患者心功能和预后的影响。

本研究纳入了接受不同给药时间的 NE 治疗和 NE 联合 SP 治疗的 SS 患者。分析血清肌钙蛋白 I(cTnI)和 B 型利钠肽(BNP)、射血分数(EF)和压力校正心率(PAR)值,以评估心功能。使用 Kaplan-Meier 方法和对数秩检验收集并评估 28 天生存率信息。

NE 治疗可显著改善 SS 患者的心功能,特别是在输液后 2 小时给予 NE 的患者,表现为 BNP 和 cTnI 水平升高,EF%和 RAP 降低。在 NE-2 小时组中,与 NE-1 小时和-3 小时组相比,SS 患者的 28 天生存率更高。此外,接受 NE 联合 SP 治疗的患者心功能明显改善,生存率提高。

综上所述,本研究结果表明,输液后 2 小时给予 NE 可能是 SS 治疗的最佳时间点,NE 联合 SP 治疗可改善 SS 患者的早期心功能障碍和 28 天生存率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed9c/7683914/f435c48e9375/10.1177_2058738420950583-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed9c/7683914/9a4731744aad/10.1177_2058738420950583-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed9c/7683914/f435c48e9375/10.1177_2058738420950583-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed9c/7683914/9a4731744aad/10.1177_2058738420950583-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ed9c/7683914/f435c48e9375/10.1177_2058738420950583-fig2.jpg

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本文引用的文献

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Sepsis and septic shock.脓毒症和脓毒性休克。
Lancet. 2018 Jul 7;392(10141):75-87. doi: 10.1016/S0140-6736(18)30696-2. Epub 2018 Jun 21.
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Intermedin1-53 protects cardiac function in rats with septic shock via inhibiting oxidative stress and cardiomyocyte apoptosis.中介素 1-53 通过抑制氧化应激和心肌细胞凋亡保护脓毒性休克大鼠的心功能。
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Mechanisms underlying the increased cardiac norepinephrine spillover in heart failure.心力衰竭中心脏去甲肾上腺素溢出增加的机制。
超声心动图评价去甲肾上腺素对脓毒症患者心功能的影响。
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α-adrenergic blockade attenuates septic cardiomyopathy by increasing cardiac norepinephrine concentration and inhibiting cardiac endothelial activation.α-肾上腺素能阻断通过增加心脏去甲肾上腺素浓度和抑制心脏内皮细胞激活来减轻脓毒症性心肌病。
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