瑞舒伐他汀对脓毒性休克患者的血清乳酸水平的影响及其治疗疗效分析
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摘要
目的:评估瑞舒伐他汀对脓毒性休克患者血清乳酸水平的影响及其临床疗效。方法:收集2014-05-2015-07期间入住我院ICU并确诊为脓毒性休克的66例患者,随机分入对照组和干预组。干预组38例,男24例,女14例;年龄21～80岁,平均(51.76±16.48)岁。对照组28例,男12例,女16例;年龄38～78岁,平均(52.86±14.56)岁。治疗组采用瑞舒伐他汀以及常规治疗,对照组仅采用西医常规治疗。疗效评估方法分别记录两组患者入院时以及入院后12、24、48 h血清乳酸浓度;分别于入院时和治疗7 d后时采用APACHEⅡ评分标准对两组患者进行评估。结果:干预组及对照组的年龄、性别构成、原发病构成以及入院时的血清乳酸水平和APACHEⅡ评分差异无统计学意义(P>0.05)。与对照组相比,干预组能显著降低脓毒性休克患者入院后12、24、48 h的血清乳酸浓度(P<0.05);与入院时相比,两组患者的APACHEⅡ评分均降低;但治疗7 d后,干预组的APACHEⅡ评分较对照组降低更为显著(P<0.05)。结论:瑞舒伐他汀能明显降低脓毒性休克患者的血清乳酸水平和APACHEⅡ评分,具有较好的近期疗效。
Objective: To evaluate the change of serum lactic acid and clinical outcome of Rosuvastatin on the septic shock. Method: In this double-binded, randomized controlled, parallel-group tiral, 66 patients with septic shock from May 2014 to July 2015 were divided into two groups: intervention group and control group. Intervention group including 24 males and 14 females with an average age of 51.76±16.48(range, 21 to 80), Control group including 12 males and 16 females with an average age of 52.86±14.56(range, 38 to 78). Control group accepted routine medical therapy, while Intervention group was treated with Rosuvastatin and routine medical therapy. The serum lactic acid was measured before therapy and 12 hours, 24 hours, 48 hours after therapy. The APACHE Ⅱ scores were evaluated at the first day and 7 days after therapy. Result: There were no significantly difference of age, gender, primary disease, the serum lactic acid and the scores of APACHE Ⅱ between two groups. 1. When compared to Control group, the level of serum lactic acid of intervention group at 12 hours, 24 hours and 48 hours after therapy was decreased significantly. Compared to admission, the APACHE Ⅱ scores of two groups, which were evaluated 7 days after therapy, were decreased significantly, while the intervention group decreased apparently. Conclusion: Rosuvastatin would decrease the level of serum lactic acid, and the clinical outcomes are satisfactory to treat septic shock combined with Rosuvastatin and routine therapy.
Objective: To evaluate the change of serum lactic acid and clinical outcome of Rosuvastatin on the septic shock. Method: In this double-binded, randomized controlled, parallel-group tiral, 66 patients with septic shock from May 2014 to July 2015 were divided into two groups: intervention group and control group. Intervention group including 24 males and 14 females with an average age of 51.76±16.48(range, 21 to 80), Control group including 12 males and 16 females with an average age of 52.86±14.56(range, 38 to 78). Control group accepted routine medical therapy, while Intervention group was treated with Rosuvastatin and routine medical therapy. The serum lactic acid was measured before therapy and 12 hours, 24 hours, 48 hours after therapy. The APACHE Ⅱ scores were evaluated at the first day and 7 days after therapy. Result: There were no significantly difference of age, gender, primary disease, the serum lactic acid and the scores of APACHE Ⅱ between two groups. 1. When compared to Control group, the level of serum lactic acid of intervention group at 12 hours, 24 hours and 48 hours after therapy was decreased significantly. Compared to admission, the APACHE Ⅱ scores of two groups, which were evaluated 7 days after therapy, were decreased significantly, while the intervention group decreased apparently. Conclusion: Rosuvastatin would decrease the level of serum lactic acid, and the clinical outcomes are satisfactory to treat septic shock combined with Rosuvastatin and routine therapy.
引文
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[13] 李华,李玉东,杨守忠,等.辛伐他汀对高糖损伤血管内皮细胞的保护作用研究[J].重庆医学,2014,43(30):4037-4039.
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[15] Lee CC,Lee MG,Hsu TC,et al.A population-based cohort study on the drug-specific effect of statins on sepsis outcome[J].Chest,53(4):805-815.
[16] Cawcutt KA,Peters SG.Severe sepsis and septic shock:clinical overview and update on management[J].Mayo Clinic Proceedings,2014,89(11):1572-1578.
[17] Rochwerg B,Alhazzani W,Sindi A,et al.Fluid resuscitation in sepsis:a systematic review and network meta-analysis[J].Ann Intern Med,2014,161(5):347-55.
[2] Azevedo LC.The many facets of sePsis PathoPhysiology and treatment[J].Shock,2013,39(Suppl 1):1-2.
[3] Marik PE.Early management of severe sepsis[J].Chest,2014,145(6):1407-1418.
[4] 王慧,赵灵燕.早期血乳酸测定在严重脓毒血症与感染性休克中的意义[J].中国社区医师,2015,31(29):117-118.
[5] Piechota M,Barylski M,Hannam S,et al.Rationale of statin therapy in septic patients[J].Curr Vasc Pharmacol,2013,11(5):795-800.
[6] Godinjak A,Iglica A,Rama A,et al.Predictive value of SAPS Ⅱ and APACHE Ⅱ scoring systems for patient outcome in medical intensive care unit[J].Acta Med Acad,2016,45(2):97-103.
[7] Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[8] 程静,马乐,苏春芳.动脉血乳酸及早期乳酸清除率与老年COPD合并呼吸衰竭患者预后的相关性[J].实用医学杂志,2016,32(6):952-954.
[9] 董梅.他汀类药物临床应用的多效性[J].实用医学杂志,2013,29(19):3262-3264.
[10] 王震,魏玉杰,刘惠亮,等.他汀类药物抗凝作用的研究进展[J].中国动脉硬化杂志,2016,24(3):316-320.
[11] 牛丽丹,张建新,郝同琴,等.阿托伐他汀联合低分子肝素抗凝治疗对脓毒症患者的疗效观察[J].临床药物治疗杂志,2017,15(6):22-25.
[12] 武云涛,张薇,田国祥,等.不同剂量辛伐他汀对冠状动脉粥样硬化症患者血管内皮细胞功能的影响[J].中国循证心血管医学杂志,2014,6(2):162-165.
[13] 李华,李玉东,杨守忠,等.辛伐他汀对高糖损伤血管内皮细胞的保护作用研究[J].重庆医学,2014,43(30):4037-4039.
[14] Niessner A,Steiner S,SPeidl WS,et al.Simvastatin suppresses endotoxin-induced upregulation of toll-like receptors 4 and 2 in vivo[J].Atherosclerosis,2006,189(2):408-413.
[15] Lee CC,Lee MG,Hsu TC,et al.A population-based cohort study on the drug-specific effect of statins on sepsis outcome[J].Chest,53(4):805-815.
[16] Cawcutt KA,Peters SG.Severe sepsis and septic shock:clinical overview and update on management[J].Mayo Clinic Proceedings,2014,89(11):1572-1578.
[17] Rochwerg B,Alhazzani W,Sindi A,et al.Fluid resuscitation in sepsis:a systematic review and network meta-analysis[J].Ann Intern Med,2014,161(5):347-55.