The Study Of Hydroxyethyl Starch (130/0.4) On Tissue Perfusion Of Patients With Septic Shock

Backgroundsepsis is systemic inflammatory reaction syndrome(SIRS) which came from infection. Progressive sepsis will be septic shock. Developing of anti-infection therapy, immune therapy and intensive technology, the morbidity and mortality of septic shock is still high. There were about 751,000 cases of sepsis or septic shock, and 200,000 cases were dead a year in America. Sepsis is an important reason of death in intensive care medicine. More and more critical medical worker pay close attention to sepsis. In June of 2003, a committee based on 11 association include SCCM and ESICM and 27 scholar made a new therapy guideline of septic shock that is beneficial to push about large scale clinic verification and standardize the therapy which decrease the mortality of sepsis.In the progress of sepsis aggravated to septic shock, a great deal of inflammatory cytokine lead to circulatory abnormalities(peripheral vasodilatation, intravascular volume depletion, myocardial depression, and increased metabolism)lead to an imbalance between systemic oxygen delivery and oxygen demand, resulting in global tissue hypo-perfusion or shock.The important role of sepsis which aggravated to MOF or death is hypo-perfusion in whole tissue. Without realizing the change of disease and getting right therapy in the key "golden hours",the irreversible state of disease happened.Hydroxyethyl starch (130/0.4) commodity name is Voluven, is a new type hydroxyethyl starch, with volume expansion effect, decrease leakage of capillary, inhibit the expression of inflammatory mediator and decrease the interaction of white blood cell with endothelium cell(prevent adhere of neutrophilic granulocyte, and no side effect on reanal function and coagulation. Hydroxyethyl starch (130/0.4) was used extensively in hypovolemia shock caused by blood loss or surgery, but had few clinic study of fluid resuscitation with hydroxyethyl starch (130/0.4 ) to septic shock.. ObjectiveEvaluate the effect of tissue perfusion of hydroxyethyl starch (130/0.4) to septic shock, and observe the side effect on renal function and coagulation. MethodSelected 20 patients with septic shock. according to the resuscitation goals of therapy guideline on septic shock, practice fluid resuscitation with hydroxyethyl starch (130/0.4) .The values of APACHE â…¡ score, artery blood gas analyze(including artery blood lactate concentration), mixed venous blood gas analyze, PAWP, cardiac output(CO) which was measured by thermodilution method, cardiac index(CI), LVSWI, RVSWI, SVRI, PVRI, DO2, VO2,Gastric intramucosal partial pressure of carbon dioxide(PgCO2) (automatic gas capnometry)determinations were obtained at baseline and 30min after the end of fluid infusion.,the partial pressure of carbon dioxide gap(Pg-aCO2), which is difference betweenPgCO2 and PaCO2 ,were recorded, and observed the mortality of the seventh day after fluid resuscitation. ResultsCompare to no fluid resuscitation, After fluid resuscitation with hydroxyethyl starch (130/0.4) , APACHE â…¡ score , PVRI decreased, PAWP, CI, SVRI, LVSWI, DO2 rised, with statistics difference(P<0.01); RVSWI, VO2 rised, but no statistics difference(P<0.01); artery blood lactate concentration(ABL) and Pg-aCO2 decreased, and from 7.56mmol/L and 15.49mmHg to 5.98mmol/L and 11.72 mmHg respectively, with statistics difference(P<0.01); moreover, ABL and Pg-aCO2 has significant correlation(r=0.546, P<0.05). In 20 cases, survived 9 cases(45%), dead 11 cases(55%);dead group Pg-aCO2 and ABL are marked higher than survived group, no matter fluid resuscitation. Pg-aCO2 and ABL in dead group decreased slightly, but no statistics difference(P>0.05), in survived group decreased significantly, with statistics difference(P<0.01). There are no notable change(P>0.05) in blood Cr, PT, APTT and blood platelet no matter fluid resuscitation. Inclusions1. Hydroxyethyl starch (130/0.4 ) has significant effect on volume expansion2. Hydroxyethyl starch (130/0.4) improves tissue perfusion and gastric mucosal blood flow.3. Hydroxyethyl starch (130/0.4) has no side effect...