肝素联合山莨菪碱对脓毒性休克乳酸酸中毒治疗探索.doc

肝素联合山莨菪碱对脓毒性休克乳酸酸中毒治疗探索 　　[摘要] 目的 探索肝素联合山莨菪碱对脓毒性休克乳酸酸中毒的治疗作用。方法 方便收集2015年5月―2016年5月福建省立金山医院收治的符合条件的脓毒性休克致乳酸酸中毒患者42例，随机分成A、B两组，A组与常规集束化治疗，B组在常规集束化治疗基础上加用肝素及山莨菪碱。比较两组患者的6、12 h乳酸清除率，每小时尿量，入院24 h APACHEⅡ评分。结果 A组患者6、12 h乳酸清除率[（0.25±0.10）、（0.57±0.16）]明显低于B组[（0.33±0.13）、（0.67±0.10）]（t=2.174， 2.536， P=0.036， 0.015）；24 h APACHEⅡ评分[（11.41±3.30）分]小于A组（13.57±3.59）分]（t=2.058， P=0.046）；尿量（1.04±0.54）较A组（0.59±0.28）明显增加（t=3.426， P=0.001）。结论 肝素联合山莨菪碱可提高脓毒性休克乳酸酸中毒患者的6、12 h乳酸清除率，改善尿量，改善病情。这可能和山莨菪碱、肝素联合使用具有改善微循环、抗凝、抗炎等作用有关 [关键词] 肝素；山莨菪碱；脓毒性休克；乳酸酸中毒；APACHEⅡ评分 [中图分类号] R720.597 [文献标识码] A [文章编号] 1674-0742（2017）01（c）-0038-04 Treatment Exploration of Heparin and Anisodamine on the Septic Shock Lactic Acidosis LIN Xing-sheng1，2， SHI Song-chang1， SHI Song-jing2 1.Department of First ICU， Fujian Provincial Jinshan Hospital， Fuzhou， Fujian Province， 350028 China；2.Department of Second ICU， Fujian Provincial Hospital， Fuzhou， Fujian Province， 350001 China [Abstract] Objective To explore the treatment effect of heparin and anisodamine on the septic shock lactic acidosis. Methods Convenient selection 42 cases of patients with septic shock lactic acidosis admitted and treated in our hospital from May 2015 to May 2016 were collected and randomly divided into two groups， the group A adopted the routine cluster treatment， while the group B adopted the heparin and anisodamine on the basis of the group A， and the 6h and 12h lactic clearance rates， urine output per hour and APACHEⅡ score at 24 h after admission of the two groups were compared. Results The 6 h and 12 h lactic clearance rates in the group B were obviously higher than those in the group A[（0.25±0.10）， （0.57±0.16）， （0.33±0.13）， （0.67±0.10）]（t=2.174， 2.536， P=0.036， 0.015）， the 24 h APACHEⅡ score was lower than that in the group A[（11.41±3.30）points vs （13.57±3.59）points] （t=2.058， P=0.046）， and the urine output obviously increased compared with that in the group A， [（1.04±0.54） vs （0.59±0.28）]（t=3.426， P=0.001）. Conclusion Hep