Effect Of Terlipressin On Renal Perfusion In Patients With Septic Shock

Part One: Effect of terlipressin on renal perfusion in patients with septic shockOBJECTIVE:Observe the blood perfusion of renal cortical area after application of terlipressin by contrast-enhanced ultrasonography(CEUS)and its quantitative analysis technology.The aim was to investigate the effect of terlipressin on renal blood perfusion in patients with septic shock.Methods:From September 2019 to January 2020,May to June 2020,patients with septic shock who were admitted to the Department of Critical Care Medicine of Zhongda Hospital of Southeast University were selected as the research subjects,and randomly divided into control groups:Norepinephrine group,Norepinephrine was pumped continuously by central vein to maintain the target mean arterial pressure(MAP)≥65mmHg,experimental group:Terlipressin was pumped continuously by central vein with 1.3ug/kg/h,adjusting the NE dose to maintain MAP≥65mmHg.The conventional ultrasound and contrast-enhanced ultrasonography were performed on the right kidney at the beginning of enrollment(T0)and 24 hours after enrollment(T24)to observe blood perfusion in the renal cortex continuously.Trace the time-intensity curve(TIC)curve reflecting the change of microbubble echo intensity,and obtain the corresponding quantitative parameters:Peak intensity(PI),time to peak(TTP),regional blood volume(RBV),regional blood flow(RBF),mean transit time(MTT).Color Doppler ultrasound was used to detect renal resistive index(RI);blood samples were taken before each angiography to measure blood serum creatinine(Scr)and blood serum urea nitrogen(BUN).Compare the two groups of quantitative parameters and RI,Scr,BUN for statistical significance.Results:(1)Comparison of general conditions of patients in the trial:A total of 22 patients with septic shock were included in the study,including 10 in the terlipressin group and 12 in the norepinephrine group.There were no significant differences in baseline age,height,APACHEII score,SOFA score,and infection site in the two groups.(2)Comparison of contrast-enhanced ultrasonography results between the two groups of patients at T0:At the beginning of enrollment(T0),Patients in the terlipressin group and norepinephrine,had PI(59.2±7.0vs.54.1±10.8,p=0.215),TTP[20.2±4.4 vs.19.0(13.2,23.2),p=0.456],RBV(5427±2480 vs.4416± 1334,p=0.268),RBF(80.0±9.5 vs.72.1 ± 14.7,p=0.161)and MTT[60.4(44.6,77.9)vs.61.6± 17.3,p=0.722],there was no statistical difference.(3)The results of contrast-enhanced ultrasonography results at the T24 after enrollment:In TP and NE groups,PI was 60.5±8.6,52.4±7.0(p=0.025),TTP was 22.5±8.8,19.7±9.7(p=0.037),and RBV was 5899 ±2423,4551± 1399(p=0.118),RBF was 80.9± 12.8,70.4±8.6(p=0.033)and MTT was 74.6±33.3,64.3±22.0(p=0.394),There were statistical differences with PI,TTP,RBF comparison,but RBV and MTT were not statistically significant.(4)Comparison of contrast-enhanced ultrasonography in the terlipressin group at T0 and T24:PI(59.2±7.0 vs.60.5±8.6,p=0.717),TTP(20.2±4.4 vs.22.5±8.8,p=0.455),RBV(5427±2480 vs.5899±2423,p=0.672),RBF(80.0±9.5 vs.80.9± 12.8,p=0.863)and MTT[60.4(44.6,77.9),74.6±33.3,p=0.579],There was no statistical difference.(5)Comparison of changes in contrast-enhanced ultrasonography after 24 hours between the two groups of patients:PI change(1.3±6.1 vs.-1.7± 9.5,p=0.400),TTP change(2.4±6.3 vs.-3.6±7.4,p=0.059),RBV change(473±2586 vs.134±1215,p=0.690),RBF change[0.9±8.4 vs.14.7(-9.9,0.9),p=0.288]and MTT change(7.8±35.2 vs.2.7± 13.8,p=0.653),there was no statistical difference.(6)Comparison of renal vascular resistance index RI and renal function between the two groups:At T0,The size of RI was 0.68±0.045,0.71±0.059(p=0.182),Scr was 86±21,82(51,160)(p=0.923)and BUN was 10.0±3.8,8.8±4.2(p=0.475)in patients in TP and NE group.The difference was not statistically significant(P>0.05);Correspondingly at T24,The size of RI was 0.70±0.059,0.71±0.053(p=0.651),Scr was 66±27,64(47,161)(P=0.771)and BUN was 10.7±3.2,9.4±4.1(p=0.416),there was no statistically significant difference.Conclusion:1.Terlipressin can early improve renal blood perfusion in patients with septic shock 2.Terlipressin cannot early improve renal vascular resistance index,blood creatinine and urea nitrogen levels in patients with septic shock.Part Two:the effect of terlipressin critical closing pressure and mean systemic filling pressureObjective:Observe the effect of terlipressin on critical closing pressure and mean systemic filling pressureMethods:(1)Prospectively observe patients with septic shock diagnosed and treated in the Department of Critical Care Medicine of Zhongda Hospital of Southeast University from September 2019 to January 2020,May to June 2020.(2)All patients were placed with a central venous catheter via the left or right internal jugular vein and a femoral artery catheter via the left or right femoral artery for pulse indication continuous cardiac output(PiCCO)monitoring;(3)All patients were given tracheal intubation and had ventilator-assisted ventilation with analgesia and sedation.if necessary,gave remifentanil intravenously,until there was no spontaneous breathing at all,then adjusted the end-expiratory pressure to reach 5,10,15cmH20,pressed and held the inspiratory hold button for 12s.At 9-12s after the start of breath holding,read cardiac output CO,central venous pressure CVP,mean arterial pressure MAP;(4)Constructed the venous return(VR)curve of the three pairs of CO and CVP values obtained at three pressure levels.The intercept value of the curve on the X axis is the mean systemic filling pressure Pmsf;Similarly,constructed cardiac output(VO)curve through 3 pairs of CO and Pa values by linear regression analysis,the intercept value of this curve on the X axis is the critical closing pressure Pcc.Results:(1)Comparison of general conditions of patients in the trial:The study included 13 patients with septic shock,including 6 cases in the terlipressin group and 7 cases in the norepinephrine group.The baseline age,height,APACHEII score,SOFA score,and infection site of the two groups Significant differences.(2)Comparison of hemodynamic parameters between the two groups of patients at T0:The corresponding parameters of the arterial system MAP(83± 10 vs.80±9,P=0.512),Pcc(12±27 vs.7±33,P=0.762),MAP-Pcc(71±33 vs.56(49,75),p=1.000)and Ra(17.15± 10.19 vs.13.02±7.14,p=0.410)were not statistically different;Pmsf[36± 14,47(34,63),p=0.295],CVP(14±6,13±4,p=0.674),Pmsf-CVP[22± 13,30(24,55),p=0.181]and Rv(4.39±1.44,9.90 ±5.27,p=0.051)There was no statistical difference.(3)Comparison of hemodynamic parameters between the two groups after 24 hours:T24,arterial system corresponding parameters MAP(76± 12 vs.83± 17,P=0.382),Pcc(20±24 vs.10±43,P=0.644),MAP-Pcc(56±33 vs.73±34,p=0.673)and Ra(11.95±5.18 vs.10.85±3.94,p=0.384)were not statistically different;Pmsf(34± 12,55 ±24,p=0.071),CVP(14±5,12±2,p=0.391),Pmsf-CVP(20± 13,43±24,p=0.381)and Rv(5.09±2.56,6.56±3.15,p=0.059)There was no statistical difference(4)Patients whose Pcc was less than Pmsf A total of 13 patients were included in the study:Among them,11 patients had Pcc less than Pmsf at the initial enrollment,Pcc-Pmsf value was-29(-75,-13);After 24h,9 patients had Pcc less than Pmsf,the Pcc-Pmsf value was-37(-70,-17).Conclusion:Terlipressin did not significantly change the critical closing pressure and mean systemic filling pressure...