解放军医学杂志2017，Vol.42Issue(9)：805-809,5.DOI:10.11855/j.issn.0577-7402.2017.09.10
前列地尔对感染性休克合并急性呼吸窘迫综合征患者的临床疗效观察
Clinical effect of alprostadil in patients with septic shock associated with acute respiratory distress syndrome
摘要
Abstract
Objective To evaluate the clinical efficacy of alprostadil in patients with septic shock associated with acute respiratory distress syndrome (ARDS),and to explore its possible mechanism.Methods From January 2015 to June 2016,patients with septic shock associated with ARDS and meeting the inclusion criteria were involved in the study in department of critical care medicine in First Hospital of Lanzhou University and randomly divided into the control group and alprostadil group.The standard treatment was given in control group,alprostadil 10μg 2/d was given in alprostadil group on base of standard treatment.Monitoring indexes were recorded in 1,3 and 6 days after enrollment.General condition of patients,APACHE Ⅱ score,ventilator conditions (PO2,PCO2,RR,PEEP,FiO2,oxygenation index,airway resistance,lung compliance),mechanical ventilation time,ICU stay time,hospital follow-up,28-day follow-up,immune index (CD4+/CD8+),inflammatory markers (CRP,PCT,IL-6) were monitored.Results Sixty-five patients were included in this study,32 in control group and 33 in alprostadil group.At 3 and 6 days after the treatment,APACHE Ⅱ score,respiratory rate (RR),the inspired oxygen concentration (FiO2),airway resistance,and C reactive protein (CRP),procalcitonin (PCT)-6 and interleukin (IL-6) levels significantly decreased,compared with pretreatment and 1 day posttreatment,in the two groups and lower in alprostadil group than in the control group on the 6th day (P＜0.05);at the same time,these indexes such as arterial partial pressure of oxygen (PaO2),lung compliance,oxygenation index,CD4+/CD8+ significantly increased 3 and 6 days after the treatment compared with pretreatment and 1 day posttreatment in the two groups,and on the 6thday,significantly higher in the alprostadil group than in the control group (P＜0.05).Time of mechanical ventilation,ICU stay and hospital stay in the alprostadil group was respectively lower than that in the control group (P＜0.05);The hospital mortality and the 28-day mortality rate were significantly lower in the alprostadil group than in the control group (P＜0.05).Conclusion Alprostadil can improve the lung function in patient with septic shock associated with ARDS,shorten the time of mechanical ventilation,ICU stay and hospital stay,and reduce the mortality rate,which may be associated with that alprostadil reduces systemic inflammatory reaction and enhance immunity by improving microcirculation.关键词
前列地尔/休克,脓毒性/呼吸窘迫综合征,成人Key words
Alprostadil/shock, septic/respiratory distress syndrome, adult分类
医药卫生引用本文复制引用
刘丽平,胡生文,帅佃奎,邓园园,王林军,李玉民..前列地尔对感染性休克合并急性呼吸窘迫综合征患者的临床疗效观察[J].解放军医学杂志,2017,42(9):805-809,5.基金项目
甘肃省自然科学基金(1506RJZA255)This work was supported by the Natural Science Foundation of Gansu (1506RJZA255) （1506RJZA255）
