2024 年第 1 期 第 19 卷

人血白蛋白联合液体复苏对脓毒症休克并发急性呼吸窘迫综合征患者炎症因子水平及血流动力学的影响

The effect of human serum albumin combined with liquid resuscitation on inflammatory factors levels and hemodynamics in patients with septic shock complicated with acute respiratory distress syndrome

作者：张辉 赵磊 甄洁 边伟帅 陈炜

英文作者：Zhang Hui Zhao Lei Zhen Jie Bian Weishuai Chen Wei

单位：首都医科大学附属北京世纪坛医院重症医学科，北京100038

英文单位：Department of Intensive Care Medicine Beijing Shijitan Hospital Capital Medical University Beijing 100038 China

关键词：脓毒症休克；急性呼吸窘迫综合征；人血白蛋白；液体复苏；炎症因子；血流动力学

英文关键词：Septicshock;Acuterespiratorydistresssyndrome;Humanalbumin;Fluidresuscitation;Inflammatoryfactors;Hemodynamics

• 摘要：

• 目的  探讨人血白蛋白联合液体复苏对脓毒症休克并发急性呼吸窘迫综合征（ARDS）患者炎症因子水平及血流动力学的影响。方法  选取2019年8月至2021年8月首都医科大学附属北京世纪坛医院收治的153例诊断后24 h的脓毒症休克并发ARDS患者。依照随机数字表法分为对照组（76例）和观察组（77例）。对照组在常规治疗基础上给予液体复苏治疗，观察组在对照组治疗的基础上给予人血白蛋白治疗。比较2组28 d病死率、机械通气时间、重症监护病房（ICU）住院时间及补液量，治疗前24 h和治疗后24 h的去甲肾上腺素用量、液体平衡量，治疗前和治疗后24 h血清C反应蛋白、白细胞介素6、肿瘤坏死因子α水平、心率、中心静脉压及平均动脉压。观察患者治疗期间的不良反应。结果  2组28 d病死率差异无统计学意义（P>0.05）。观察组机械通气时间、ICU住院时间短于对照组，补液量少于对照组，治疗后24 h观察组去甲肾上腺素用量少于对照组、液体负平衡量多于对照组，差异均有统计学意义（均P<0.001）。治疗后24 h观察组血清C反应蛋白、白细胞介素6、肿瘤坏死因子α水平和心率低于对照组，中心静脉压和平均动脉压高于对照组［（138±12）mg/L比（158±18）mg/L、（62±5）ng/L比（76±6）ng/L、（11.1±1.1）ng/L比（13.3±1.2）ng/L、（82±5）次/min比（92±7）次/min、（11.0±1.2）mmHg（1 mmHg=0.133 kPa）比（9.8±1.4）mmHg、（79±4）mmHg比（72±4）mmHg］，差异均有统计学意义（均P<0.001）。所有患者于治疗期间均无严重的不良反应发生。结论  人血白蛋白联合液体复苏治疗脓毒症休克并发ARDS患者的临床效果较好，有助于缩短患者机械通气时间和ICU住院时间，减轻炎症反应，改善血流动力学指标。

• Objective  To investigate the effect of human serum albumin combined with liquid resuscitation on inflammatory factors levels and hemodynamics in patients with septic shock complicated with acute respiratory distress syndrome(ARDS). Methods  Totally 153 cases of patients with septic shock complicated with ARDS admitted to Beijing Shijitan Hospital, Capital Medical University from August 2019 to August 2021 were selected. They were divided into the control group(76 cases) and the observation group(77 cases) according to the random number table method. The control group received liquid resuscitation treatment on the basis of routine treatment, while the observation group received human blood albumin treatment on the basis of the control group. The 28 d mortality rate, duration of mechanical ventilation, length of stay in intensive care unit(ICU) and fluid replacement volume, norepinephrine dosage and fluid balance volume 24 h before treatment and 24 h after treatment, levels of serum C-reactive protein, interleukin-6, tumor necrosis factor-α, heart rate, central venous pressure and mean arterial pressure before treatment and 24 h after treatment were compared between the two groups. Adverse reactions of the patients during treatment were observed. Results  There was no statistically significant difference in the 28 d mortality rate between the two groups(P>0.05). The time of mechanical ventilation and length of stay in ICU in the observation group were shorter than those in the control group, the amount of fluid replacement was less than that in the control group, the amount of norepinephrine in the observation group was less than that in the control group 24 h after treatment, and the negative balance of fluid was more than that in the control group (all P<0.001). The levels of serum C-reactive protein, interleukin-6, tumor necrosis factor-α, and heart rate in the observation group were lower than those in the control group, and the central venous pressure and mean arterial pressure were higher than those in the control group 24 h after treatment ［(138±12)mg/L vs (158±18)mg/L, (62±5)ng/L vs (76±6)ng/L, (11.1±1.1)ng/L vs (13.3±1.2)ng/L, (82±5)times/min vs (92±7)times/min, (11.0±1.2)mmHg vs (9.8±1.4)mmHg, (79±4)mmHg vs (72±4)mmHg］(all P<0.001). No serious adverse reactions occurred in the patients during the treatment period. Conclusions  The clinical effects of human albumin combined with fluid resuscitation in treatment of patients with septic shock complicated with ARDS is significant, which can reduce the mechanical ventilation time and ICU stay time, reduce the inflammatory response and improve the hemodynamic indexes.