Clinical effect of alprostadil in patients with septic shock associated with acute respiratory distress syndrome

Objective To evaluate the clinical efficacy of alprostadil in patients with septic shock associated with acute respiratory distress syndrome (ARDS), and to explore its possible mechanism. Methods From January 2015 to June 2016, patients with septic shock associated with ARDS and meeting the inclusion criteria were involved in the study in department of critical care medicine in First Hospital of Lanzhou University and randomly divided into the control group and alprostadil group. The standard treatment was given in control group, alprostadil 10μg 2/d was given in alprostadil group on base of standard treatment. Monitoring indexes were recorded in 1, 3 and 6 days after enrollment. General condition of patients, APACHE Ⅱ score, ventilator conditions (PO2, PCO2, RR, PEEP, FiO2, oxygenation index, airway resistance, lung compliance), mechanical ventilation time, ICU stay time, hospital follow-up, 28-day follow-up, immune index (CD4+/CD8+), inflammatory markers (CRP, PCT, IL-6) were monitored. Results Sixty-five patients were included in this study, 32 in control group and 33 in alprostadil group. At 3 and 6 days after the treatment, APACHE Ⅱ score, respiratory rate (RR), the inspired oxygen concentration (FiO2), airway resistance, and C reactive protein (CRP), procalcitonin (PCT) -6 and interleukin (IL-6) levels significantly decreased, compared with pretreatment and 1 day posttreatment, in the two groups and lower in alprostadil group than in the control group on the 6th day (P<0.05); at the same time, these indexes such as arterial partial pressure of oxygen (PaO2), lung compliance, oxygenation index, CD4+/CD8+ significantly increased 3 and 6 days after the treatment compared with pretreatment and 1 day posttreatment in the two groups, and on the 6th day, significantly higher in the alprostadil group than in the control group (P<0.05). Time of mechanical ventilation, ICU stay and hospital stay in the alprostadil group was respectively lower than that in the control group (P<0.05); The hospital mortality and the 28-day mortality rate were significantly lower in the alprostadil group than in the control group (P<0.05). Conclusion　Alprostadil can improve the lung function in patient with septic shock associated with ARDS, shorten the time of mechanical ventilation, ICU stay and hospital stay, and reduce the mortality rate, which may be associated with that alprostadil reduces systemic inflammatory reaction and enhance immunity by improving microcirculation. DOI: 10.11855/j.issn.0577-7402.2017.09.10