去甲肾上腺素和特利加压素及其联合使用在脓毒症休克患者中的疗效对比研究-现代医学

去甲肾上腺素和特利加压素及其联合使用在脓毒症休克患者中的疗效对比研究

单位：1. 内蒙古医科大学包头临床医学院, 内蒙古包头 014000;
2. 包头市中心医院重症医学科, 内蒙古包头 014000

分类号：R459.7

出版年·卷·期（页码）：2026·54·第六期（945-953）

摘要：

目的：探讨锂稀释心排血量血流动力学监测系统(LiDCO)监测下特利加压素(TP)、去甲肾上腺素(NE)单独及联合使用对脓毒症休克患者的血流动力学影响及临床疗效。方法：依据纳入和排除标准，选取2024年8月至2025年8月包头市中心医院重症医学科收治的脓毒症休克患者180例，按随机数字表法分为3组，各60例。3组患者均给予基础治疗，NE单药组单独使用NE，TP单药组单独使用TP，NE+TP联合治疗组采用NE联合TP治疗，均以维持平均动脉压≥65 mmHg为目标。比较3组患者治疗前及治疗后48 h的血流动力学指标、序贯器官衰竭评分(SOFA)、急性生理与慢性健康状况评估Ⅱ(APACHE Ⅱ)评分、血乳酸水平及炎症因子水平。结果：治疗后3组各指标均较治疗前改善(均P<0.05)。联合组治疗后氧输送(DO₂)及中心静脉氧饱和度(SvO₂)均显著高于NE单药组与TP单药组；3组心指数(CI)、全身血管阻力指数(SVRI)比较，差异无统计学意义(均P>0.05)。治疗48 h后，联合组SOFA评分、APACHE Ⅱ评分、血乳酸、降钙素原(PCT)及C反应蛋白(CRP)水平均低于NE组和TP组，TP组亦优于NE组(均P<0.05)。重复测量方差分析显示，上述指标均存在显著组间效应、时间效应及交互效应(均P<0.05)。3组不良反应发生率比较，差异无统计学意义(29.31% vs. 28.81% vs. 27.12%，P=0.963)。结论：TP与NE联合使用治疗脓毒症休克的临床疗效优于单一用药，能更有效改善患者血流动力学状态、减轻器官功能损伤且不增加不良反应发生率，安全性良好。

Objective: To explore the hemodynamic effects and clinical efficacy of terlipressin(TP), norepinephrine(NE) alone, and their combination under LiDCO monitoring in patients with septic shock.Methods: A total of 180 patients with septic shock admitted to the Intensive Care Unit(ICU) of Baotou Central Hospital from August 2024 to August 2025, were selected according to inclusion and exclusion criteria. They were randomly assigned to three groups with 60 patients in each group. All patients received standard treatment, with NE monotherapy group receiving norepinephrine alone, TP monotherapy group receiving terlipressin alone, and the NE+TP combinationgroup receiving a combination of norepinephrine and terlipressin. The goal for all groups was to maintain a mean arterial pressure(MAP) ≥ 65 mmHg. The hemodynamic parameters, Sequential Organ Failure Assessment(SOFA) score, Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score, blood lactate levels, and inflammatory markers were compared before treatment and at 48 hours post-treatment. Results: After treatment, all indicators improved compared with before treatment in the three groups(P<0.05). After treatment, oxygen delivery(DO₂) and central venous oxygen saturation(SvO₂) were significantly higher in the combination group than in the NE monotherapy and TP monotherapy groups. There were no significant differences in cardiac index(CI) or systemic vascular resistance index(SVRI) among the three groups(all P>0.05). At 48 h after treatment, SOFA score, APACHE Ⅱ score, blood lactate, procalcitonin(PCT), and C-reactive protein(CRP) levels were significantly lower in the combination group than in the NE and TP groups, and these indicators were also better in the TP group than in the NE group(all P<0.05). Repeated-measures ANOVA showed significant group, time, and group × time interaction effects for these indicators(all P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups(29.31%, 28.81%, and 27.12%; P=0.963).Conclusion:The combination of terlipressin and norepinephrine for the treatment of septic shock is more effective than monotherapy in improving hemodynamic status, reducing organ dysfunction, and achieving better clinical outcomes without increasing the incidence of adverse reactions, demonstrating good safety.

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