Dong Rensong, Zhang Xi, Zhao Zhi
Department of Pharmacy, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Evid Based Complement Alternat Med. 2021 Jun 16;2021:4231454. doi: 10.1155/2021/4231454. eCollection 2021.
Septic shock is the most serious complication of sepsis, leading to unacceptably high morbidity and mortality worldwide. Fluid resuscitation using crystalloids has become the mainstay of early and aggressive treatment of severe sepsis and septic shock, while increased daily fluid balances from day 2 until day 7 have been related with increased mortality. Recently, pharmacological management has been recommended to combine with appropriate fluid resuscitation for the treatment of septic shock. In this study, we compared the clinical efficacy of restricting volumes of resuscitation fluid strategy with or without intravenous infusion of ulinastatin (UTI) in treating patients with septic shock and additionally examined the patient's changes of the extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), systemic vascular resistance index (SVRI), cardiac function, lactic acid (LA) level, coagulation function, and renal function. The study included 182 patients with septic shock, among which 89 patients had undergone restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI and 93 patients had undergone restricting volumes of resuscitation fluid strategy alone. It was found that patients with septic shock after restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI showed an increased SVRI concomitant with declined PVPI and EVLWI, increased mean artery pressure (MAP), cardiac output (CO), left ventricular ejection fraction (LVEF), stroke volume (SV), and heart rate (HR), declined levels of cardiac troponin I (cTnI), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP), reduced LA level along with shortened prothrombin time (PT) and partially activated thrombin time (PATT), and decreased levels of blood urea nitrogen (BUN), creatinine (Cr), and uric acid (UA) when comparable to those after restricting volumes of resuscitation fluid strategy alone ( < 0.05). We also observed fewer scores of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the sequential organ failure assessment (SOFA) in patients undergoing restricting volumes of resuscitation fluid strategy with intravenous infusion of UTI than those undergoing restricting volumes of resuscitation fluid strategy alone ( < 0.05). According to the above data, it is concluded that UTI as an adjuvant therapy for restricting volumes of resuscitation fluid strategy in treating septic shock may decrease the LA level, attenuate the inflammatory response, reduce vascular permeability, prevent pulmonary edema, and restore cardiac and renal functions.
感染性休克是脓毒症最严重的并发症，在全球范围内导致了令人难以接受的高发病率和死亡率。使用晶体液进行液体复苏已成为严重脓毒症和感染性休克早期积极治疗的主要手段，而从第2天到第7天每日液体平衡增加与死亡率升高有关。最近，推荐药物治疗与适当的液体复苏联合用于治疗感染性休克。在本研究中，我们比较了限制复苏液量策略联合或不联合静脉输注乌司他丁（UTI）治疗感染性休克患者的临床疗效，并额外检查了患者血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）、全身血管阻力指数（SVRI）、心功能、乳酸（LA）水平、凝血功能和肾功能的变化。该研究纳入了182例感染性休克患者，其中89例接受了限制复苏液量策略联合静脉输注UTI，93例仅接受了限制复苏液量策略。结果发现，与仅接受限制复苏液量策略的患者相比，接受限制复苏液量策略联合静脉输注UTI的感染性休克患者SVRI升高，同时PVPI和EVLWI下降，平均动脉压（MAP）、心输出量（CO）、左心室射血分数（LVEF）、每搏输出量（SV）和心率（HR）增加，心肌肌钙蛋白I（cTnI）、N末端B型利钠肽原（NT-proBNP）和C反应蛋白（CRP）水平下降，LA水平降低，同时凝血酶原时间（PT）和部分活化凝血活酶时间（PATT）缩短，血尿素氮（BUN）、肌酐（Cr）和尿酸（UA）水平降低（P<0.05）。我们还观察到，接受限制复苏液量策略联合静脉输注UTI的患者急性生理与慢性健康状况评分系统（APACHE II）和序贯器官衰竭评估（SOFA）评分低于仅接受限制复苏液量策略的患者（P<0.05）。根据上述数据得出结论，UTI作为限制复苏液量策略治疗感染性休克的辅助治疗，可能降低LA水平，减轻炎症反应，降低血管通透性，预防肺水肿，并恢复心肾功能。
