生脉注射液对脓毒性休克早期液体复苏血管外肺水及相关因素的影响  

Effect of Shengmai injection on extravascular lung water and related factors at early fluid resuscitation stage of septic shock

作　　者：赵滋苗[1] 陆军[1] 丁月平[1] 马丹女[1] 

机构地区：[1]浙江中医药大学附属第二医院重症医学科,杭州310005

出　　处：《浙江医学》2013年第9期767-769,778,共4页Zhejiang Medical Journal

摘　　要：目的探讨生脉注射液对脓毒性休克早期液体复苏患者血管外肺水及相关因素的影响。方法选取38例感染性休克患者(生脉组20例,对照组侣例),两组患者均以液体复苏至患者中心静脉压(CVP)≥8mmHg作为复苏终点,并施以内科基础治疗。生脉组同时加用生脉注射液80ml,用5%葡萄糖注射液250ml稀释,1次/d。通过脉搏轮廓曲线连续心排血量监测技术监测两组患者液体复苏结束后即刻(T_0)、6h(T_6)、12h(T_(12))、24h(T_(24))的血管外肺水指数(EVLWI)、CVP、心排血指数(CI)、外周血管阻力指数(SVRI)、全心舒张期末容积指数(GEDVI)、胸腔内血容积指数(ITBVI)等血流动力学指标及动脉血pH值、PaO_2、PaCO_2和SaO_2、PaO_2/FiO_2的变化,并记录28d病死率。结果生脉组患者T_6、T_(12)、T_(24)时刻CI、GEDVI、ITBVI均较对照组明显增加(P<0.05或0.01),EVLWI明显降低(P<0.01);两组患者相同时点CVP、SVRI的差异均无统计学意义(均P>0.05)。生脉组T12、T24时刻PaO_2/Fi_O2均显著高于对照组(均P<0.01)。生脉组患者28d病死率明显低于对照组(P<0.05)。结论在液体复苏及常规治疗基础上,加用生脉注射液可以进一步降低脓毒性休克早期液体复苏时EVLWI,增加CI、GEDVI、PaO_2/FiO_2,可以改善休克症状、加强脏器功能保护,具有积极作用。Objective To investigate the effect of Shengmai injection on extravacular lung water and related factors at the early fluid resuscitation stage of septic shock. Methods Thirty-eight patients with septic shock were randomly assigned to the treatment group（n=20） and the control group（n=18）. Patients received basic treatment combined with fluid resuscitation until the central venous pressure （CVP） reached ≥8mmHg. Patients in treatment group additionally received Shengmai injection. The hemodynamic indices, including extra-vascular lung water index（EVLWl）, CVP, cardiac index（CI）, systemic vascular resistance index （SVRI）, global end-diastolic volume index （GEDVl）, intrathoracic blood volume index （ITBVl） and oxygenation index （PaO2/FiO2） were monitored at baseline（To）, 6（T6）, 12（T12） and 24h（T24） after ending fluid resuscitation, and the 28d mortality was also observed. Results Compared with the control group, CI, GEDVI and PaOJFiO2 increased significantly at T6,T12 and T24, while EVLWI and 28d mortality was decreased in the treatment group （ P〈0.05 or 0.01 ）. But the difference in CVP and SVRI was not statistically significant between two groups at corresponding time points（P 〉0.05）. Conclusion On the basis of the fluid resuscitation and basic treatment Shengmai injection can further improve CI, GEDVl, ITBVl and PaO2/FiO2, decrease EVLWI and 28-d mortality, but showed no effect on CVP or SVRI at the early fluid resuscitation stage of septic shock.

关 键 词：生脉注射液 脓毒性休克 血管外肺水 相关因素 

分 类 号：R278[医药卫生—中医学]