Objective: To study the effect of nalmefene in treatment of patients with septic shock.
Methods: Twenty patients, suffering from septic shock, admitted to the intensive care unit (ICU) from December, 2008 to June, 2009, were randomly divided into treatment group and control group. Following the international guidelines for management of severe sepsis and septic shock 2008 as the routine anti-shock therapy, nalmefene was administered early in the treatment group, while in the control group same amount of normal saline was given as a placebo. Hemodynamics, acute physiology and chronic health evaluation II (APACHE II) score and 28-day mortality were observed in patients.
Results: Compared with control group, mean arterial pressure (MAP, mm Hg, 1 mm Hg=0.133 kPa) in treatment group was significantly higher at 2, 6, 12, 24 hours (control group: 59.67+/-3.56, 60.50+/-2.67, 60.68+/-4.97, 61.09+/-4.92; treatment group: 65.83+/-5.76, 70.83+/-5.76, 83.63+/-5.87, 82.85+/-8.36, all P<0.05), while heart rate (HR, beat per min) decreased significantly (control group: 119.79+/-8.03, 118.56+/-11.48, 116.35+/-12.48, 114.68+/-8.91; treatment group: 103.33+/-10.87, 92.29+/-12.55, 90.49+/-17.29, 86.66+/-11.53, all P<0.05). In treatment group, cardiac index (CI, Lxmin(-1) xm(-2)) at 6, 12, 24 hours was significantly higher (control group: 3.63+/-0.13, 3.67+/-0.31, 3.76+/-0.23; treatment group: 4.01+/-0.45, 4.22+/-0.39, 4.45+/-0.32, all P<0.05). Compared with control group, urine output (mlxkg(-1) xmin(-1)) in treatment group was significantly increased at 12 hours and 24 hours (control group: 0.53+/-0.39, 0.51+/-0.40; treatment group: 0.85+/-0.25, 1.06+/-0.58, both P<0.05), while lactic acid (mmol/L) decreased significantly (control group: 5.54+/-3.98, 4.91+/-2.98; treatment group: 1.51+/-0.83, 1.14+/-0.62, both P<0.05). The APACHE II score of the treatment group lowered significantly, and it was significantly lower than the control group at 24 hours (16.1+/-1.9 vs. 21.7+/-5.2, P<0.05). Compared between the two groups, the 28-day mortality showed no significant difference (20% vs. 40%, P=0.629).
Conclusion: Based on the conventional anti-shock therapy, early use of nalmefene can improve the hemodynamics, which is conducive to ameliorate septic shock, however, there is no significant effect on 28-day mortality.