Therapeutic effect of alprostadil on hemodynamic parameters in patients with septic shock after resuscitation

Abstract

Objective To observe the effects of alprostadil on the hemodynamic indices and prognosis of patients with septic shock. Methods Between September 2016 and September 2018, 80 patients with septic shock were selected from the Department of Critical Care Medicine, Donggang Branch of First Hospital of Lanzhou University. All patients were divided into a treatment group (n= 40) and a control group (n= 40) after they reached the standard of resuscitation according to the early goal-directed therapy (EGDT). All patients were treated with general treatment such as anti-infection, mechanical ventilation, organ function maintenance and nutrition metabolism. On this basis, patients in the treatment group were injected intravenously with alprostadil microspheres injection, and those in the control group were treated intravenously with isoosmotic NaCl solution, all for 14 consecutive days. The general data, hemodynamic indices such as acute physiology and chronic health evaluation (APACHE)Ⅱ score, sequential organ failure assessment (SOFA) score, mean arterial pressure, heart rate, central venous pressure, blood lactic acid, pH value and central venous oxygen saturation (ScvO2) before and 1, 2, 7 d after treatment, inpatient mortality, 28-d mortality, ICU stay and total hospital stay were recorded in these two groups. Results There were significant differences in APACHEⅡ score, SOFA score, mean arterial pressure, heart rate, central venous pressure, blood lactic acid, pH value and ScvO2 before and 1, 2, 7 d after treatment between the treatment group and control group (F = 11.661, 8.689, 11.005, 12.006, 9.045, 10.217, 11.065, 6.031; P = 0.026, 0.043, 0.009, 0.023, 0.037, 0.045, 0.041, 0.044). Further pairwise comparison revealed that the APACHEⅡ score, SOFA score, heart rate, central venous pressure and blood lactic acid at 2, 7 d after treatment in the treatment group were significantly lower than those in the control group at the same time point (all P < 0.05). The mean arterial pressure at 1, 2, 7 d after treatment, pH value and ScvO2 at 2, 7 d after treatment in the treatment group were significantly higher than those in the control group at the same time point (all P < 0.05). The inpatient mortality [20.0% (8/40) vs. 35.0% (14/40), χ2 = 53.333, P < 0.001], 28-d mortality [25.0% (10/40) vs. 40.0% (16/40), χ2 = 48.000, P < 0.001], ICU stay [(6.7 ± 2.2) d vs. (12.2 ± 2.5) d, t = 2.831, P = 0.047], and total hospital stay [(14.4 ± 3.6) d vs. (25.2 ± 4.9) d, t = 3.007, P = 0.037] in the treatment group were significantly lower than those in the control group. Conclusion Alprostadil can effectively improve hemodynamic parameters and prognosis of patients with septic shock. Key words: Shock, septic; Alprostadil; Hemodynamics