小剂量甲状腺素对重症肺炎感染性休克合并低T_3综合征患者血流动力学及炎性因子的影响
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摘要
目的研究小剂量甲状腺素对重症肺炎(SP)感染性休克(IS)合并低T3综合征(LT3S)患者血流动力学及炎性因子的影响。方法选择2016年9月～2018年5月在大连市中心医院诊治的SP及IS合并LT3S患者99例进行研究。根据随机数字表法将其分为两组,其中观察组49例,对照组50例。对照组给予常规集束化治疗,观察组在对照组治疗基础上另给予小剂量左甲状腺素片,均连续治疗7 d。随访28 d,比较两组生存预后及用药安全性,比较治疗前后的甲状腺有关激素、血流动力学有关指标、肺功能及炎性因子。结果观察组随访28 d的生存率高于对照组,死亡率低于对照组(P <0.05)。治疗后,观察组的总三碘甲状腺原氨酸(T_3)、总甲状腺素(T_4)及游离T3(FT_3)水平高于对照组,促甲状腺激素(TSH)低于对照组(P <0.05);观察组的全身血管阻力指数(SVRI)、平均动脉压(MAP)及中心静脉压(CVP)水平高于对照组,肺血管阻力指数(PVRI)、左心做功(LCW)、右心做功(RCW)、心脏指数(CI)及每搏指数(SI)低于对照组(P <0.05);两组的肺功能有关指标比较,差异无统计学意义(P>0.05),而治疗后观察组肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平低于对照组(P <0.05);两组不良反应总发生率比较,差异无统计学意义(P> 0.05)。结论应用小剂量甲状腺素治疗SP及IS合并LT3S,能够较好地改善患者的预后,且对甲状腺有关激素、血流动力学及炎性因子均有明显的改善效果,用药安全性较高,值得给予推广。
Objective To investigate the effects of low dose thyroxine on hemodynamics and inflammatory factors in patients with severe pneumonia(SP) septic shock(IS) complicated with low T_3 syndrome(LT3 S). Methods A total of 99 patients with SP and IS combined with LT3 S who were treated in Dalian Municipal Central Hospital from September2016 to May 2018 were selected for the study. According to the random number table method, the patients were divided into two groups, 49 cases in the observation group and 50 cases in the control group. The control group was treated with conventional cluster therapy, and the observation group was given a small dose of levothyroxine Tablets on the basis of the treatment of the control group, and the treatment lasted for 7 days. The patients were followed up for 28 days,and the survival prognosis and drug safety of the two groups were compared. Thyroid hormones, hemodynamic indicators, lung function and inflammatory factors before and after treatment were compared. Results The survival rate in the observation group was higher than that in the control group, and the mortality was lower than that in the control group(P < 0.05). After treatment, triiodothyronine(T_3), tyroxine(T_4) and free thriiodothyronine(FT3) levels in the observation group were higher than those in the control group, and thyroid stimulating hormone(TSH) level was lower than that in the control group(P < 0.05). The whole body vascular resistance index(SVRI), mean arterial pressure(MAP) and central venous pressure(CVP) in the observation group were higher than those in the control group, while the pulmonary vascular resistance index(PVRI), left ventricular work(LCW), right ventricular work(RCW), cardiac index(CI) and stroke index(SI) in the observation group were lower than those in the control group(P < 0.05). There was no significant difference in lung function between the two groups(P > 0.05), while the levels of TNF-α and IL-6 in the observation group were lower than those in the control group(P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(P > 0.05). Conclusion The treatment of SP and IS combined with LT3 S with low dose thyroxine can better improve the prognosis of patients, and has obvious improvement effect on thyroid hormones, hemodynamics and inflammatory factors. The drug IS safe and worthy of promotion.
Objective To investigate the effects of low dose thyroxine on hemodynamics and inflammatory factors in patients with severe pneumonia(SP) septic shock(IS) complicated with low T_3 syndrome(LT3 S). Methods A total of 99 patients with SP and IS combined with LT3 S who were treated in Dalian Municipal Central Hospital from September2016 to May 2018 were selected for the study. According to the random number table method, the patients were divided into two groups, 49 cases in the observation group and 50 cases in the control group. The control group was treated with conventional cluster therapy, and the observation group was given a small dose of levothyroxine Tablets on the basis of the treatment of the control group, and the treatment lasted for 7 days. The patients were followed up for 28 days,and the survival prognosis and drug safety of the two groups were compared. Thyroid hormones, hemodynamic indicators, lung function and inflammatory factors before and after treatment were compared. Results The survival rate in the observation group was higher than that in the control group, and the mortality was lower than that in the control group(P < 0.05). After treatment, triiodothyronine(T_3), tyroxine(T_4) and free thriiodothyronine(FT3) levels in the observation group were higher than those in the control group, and thyroid stimulating hormone(TSH) level was lower than that in the control group(P < 0.05). The whole body vascular resistance index(SVRI), mean arterial pressure(MAP) and central venous pressure(CVP) in the observation group were higher than those in the control group, while the pulmonary vascular resistance index(PVRI), left ventricular work(LCW), right ventricular work(RCW), cardiac index(CI) and stroke index(SI) in the observation group were lower than those in the control group(P < 0.05). There was no significant difference in lung function between the two groups(P > 0.05), while the levels of TNF-α and IL-6 in the observation group were lower than those in the control group(P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(P > 0.05). Conclusion The treatment of SP and IS combined with LT3 S with low dose thyroxine can better improve the prognosis of patients, and has obvious improvement effect on thyroid hormones, hemodynamics and inflammatory factors. The drug IS safe and worthy of promotion.
引文
[1]董燕,乔莉,龚晨,等.年龄与老年人低T3综合征的相关性[J].中国老年学杂志,2016,36(20):5011-5013.
[2]刘毅.参附汤对脾肾阳虚型低T3综合征危重症患者干预的临床研究[J].中草药,2017,48(14):2925-2929.
[3]孟祥凤,刘海霞,王学慧,等.老年2型糖尿病合并低T3综合征与血8-异前列腺素F2α水平的相关性[J].中国老年学杂志,2016,36(22):5568-5570.
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[7]买买提艾力·吐尔逊,阿曼古丽·阿吉,李黎,等.重症细菌性肺炎血清甲状腺激素、炎性因子水平变化及其相关性分析[J].解放军医药杂志,2017,29(11):38-41.
[8]李盘石,陈俊峰,陈惠英.感染性休克患者降钙素原、甲状腺激素水平与APACHEⅡ评分相关性的研究[J].中国实用医药,2015,10(26):9-10.
[9]欧阳沙西,罗莉.甲状腺素片补充治疗对慢性肾脏疾病患者甲状腺激素水平的影响研究[J].国际泌尿系统杂志,2016,36(5):730-735.
[10]高波,赵琨.小剂量甲状腺素片在危重患者合并低T3综合征中的应用疗效观察[J].吉林医学,2013,34(35):7383-7384.
[11]刘琼,李春芝,高占红,等.小剂量左甲状腺素钠片对维持性血液透析PEW并低T3综合征患者营养状态及并发症的影响[J].河北医药,2018,40(11):1701-1703.
[12]袁伟峰,刘月娥,张梅,等.去甲肾上腺素联合多巴酚丁胺治疗感染性休克对患者血流动力学、血乳酸及CCr,FEH2O,FENa的影响[J].现代生物医学进展,2017,17(25):4852-4855.
[13]优丽土孜·托乎提,再努拉·阿不都艾尼.重症肺炎及感染性休克的集束治疗[J].临床医药文献杂志,2017,4(54):10529-10530.
[14] Martin K,Weiss SL. Initial resuscitation and management of pediatric septic shock[J]. Minerva Pediatr,2015, 67(2):141-158.
[15]冯燕玲,黄冰生,李劲草,等.小剂量左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭患者心功能的影响[J].国际心血管病杂志,2014,41(2):127-130.
[16]孙志宝,安庆华,郑玉明,等.感染性休克患者心脏及微循环的功能变化与β受体阻滞剂的血流动力学效应[J].中华医院感染学杂志,2016,26(7):1528-1530.
[17] Maiden MJ,Chapman MJ,Torpy DJ,et al. Triiodothyro-nine Administration in a Model of Septic Shock:A Ran-domized Blinded Placebo-Controlled Trial[J]. Crit CareMed,2016,44(6):1153-1160.
[18]李少芳,应海燕.左旋甲状腺素钠治疗危重早产儿低T3综合征的分析[J].中国妇幼健康研究,2017,28(12):1532-1534.
[19]王志国,张家明,施建丰,等.甲状腺激素和炎症介质对全身炎症反应综合征患者预后影响的预测价值[J].中国中西医结合急救杂志,2015,22(2):193-197.
[20]詹峰,宋维,陈文腾,等.小剂量左旋甲状腺素干预严重脓毒症合并正常甲状腺功能病态综合征患者疗效观察[J].中国急救医学,2017,37(2):105-108.
[21]胡圆圆.低T3综合征研究进展[J].临床与病理杂志,2015,35(12):2160-2164.
[2]刘毅.参附汤对脾肾阳虚型低T3综合征危重症患者干预的临床研究[J].中草药,2017,48(14):2925-2929.
[3]孟祥凤,刘海霞,王学慧,等.老年2型糖尿病合并低T3综合征与血8-异前列腺素F2α水平的相关性[J].中国老年学杂志,2016,36(22):5568-5570.
[4]中国医师协会急诊医师分会.中国急诊重症肺炎临床实践专家共识[J].中国急救医学,2016,36(2):97-107.
[5]中国医师协会急诊医师分会.中国急诊感染性休克临床实践指南[J].中华急诊医学杂志,2016,25(3):274-287.
[6]左龙梅,戴伯华.肾脏疾病患者低T3、T4水平检测的临床价值[J].检验医学与临床,2017,14(1):306-307.
[7]买买提艾力·吐尔逊,阿曼古丽·阿吉,李黎,等.重症细菌性肺炎血清甲状腺激素、炎性因子水平变化及其相关性分析[J].解放军医药杂志,2017,29(11):38-41.
[8]李盘石,陈俊峰,陈惠英.感染性休克患者降钙素原、甲状腺激素水平与APACHEⅡ评分相关性的研究[J].中国实用医药,2015,10(26):9-10.
[9]欧阳沙西,罗莉.甲状腺素片补充治疗对慢性肾脏疾病患者甲状腺激素水平的影响研究[J].国际泌尿系统杂志,2016,36(5):730-735.
[10]高波,赵琨.小剂量甲状腺素片在危重患者合并低T3综合征中的应用疗效观察[J].吉林医学,2013,34(35):7383-7384.
[11]刘琼,李春芝,高占红,等.小剂量左甲状腺素钠片对维持性血液透析PEW并低T3综合征患者营养状态及并发症的影响[J].河北医药,2018,40(11):1701-1703.
[12]袁伟峰,刘月娥,张梅,等.去甲肾上腺素联合多巴酚丁胺治疗感染性休克对患者血流动力学、血乳酸及CCr,FEH2O,FENa的影响[J].现代生物医学进展,2017,17(25):4852-4855.
[13]优丽土孜·托乎提,再努拉·阿不都艾尼.重症肺炎及感染性休克的集束治疗[J].临床医药文献杂志,2017,4(54):10529-10530.
[14] Martin K,Weiss SL. Initial resuscitation and management of pediatric septic shock[J]. Minerva Pediatr,2015, 67(2):141-158.
[15]冯燕玲,黄冰生,李劲草,等.小剂量左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭患者心功能的影响[J].国际心血管病杂志,2014,41(2):127-130.
[16]孙志宝,安庆华,郑玉明,等.感染性休克患者心脏及微循环的功能变化与β受体阻滞剂的血流动力学效应[J].中华医院感染学杂志,2016,26(7):1528-1530.
[17] Maiden MJ,Chapman MJ,Torpy DJ,et al. Triiodothyro-nine Administration in a Model of Septic Shock:A Ran-domized Blinded Placebo-Controlled Trial[J]. Crit CareMed,2016,44(6):1153-1160.
[18]李少芳,应海燕.左旋甲状腺素钠治疗危重早产儿低T3综合征的分析[J].中国妇幼健康研究,2017,28(12):1532-1534.
[19]王志国,张家明,施建丰,等.甲状腺激素和炎症介质对全身炎症反应综合征患者预后影响的预测价值[J].中国中西医结合急救杂志,2015,22(2):193-197.
[20]詹峰,宋维,陈文腾,等.小剂量左旋甲状腺素干预严重脓毒症合并正常甲状腺功能病态综合征患者疗效观察[J].中国急救医学,2017,37(2):105-108.
[21]胡圆圆.低T3综合征研究进展[J].临床与病理杂志,2015,35(12):2160-2164.