早期目标导向治疗基础上联合参附注射液对感染性休克患者器官功能及预后的影响  

Effects of Shenfu injection intervention based on early goal-directed therapy on organ function and prognosis in patients with septic shock

作　　者：李茂琴[1] 潘翠改[1] 王晓猛[1] 莫逊[1] 史载祥[1] 许继元[1] 许艳军[1] 韩冠杰[1] 

机构地区：[1]徐州市中心医院重症医学科,江苏徐州221009

出　　处：《中国中西医结合急救杂志》2015年第2期202-206,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：江苏省徐州市科技局社会发展资助课题（XF10C019）;江苏省徐州市医学领军人才资助项目（201109）

摘　　要：目的：探讨早期目标导向治疗（EGDT）基础上联合参附注射液对感染性休克患者器官功能及预后的影响。方法选择徐州市中心医院重症医学科收治的符合感染性休克诊断标准的患者84例，按随机信封法分为常规治疗组和参附注射液治疗组，每组42例。两组患者均给予常规治疗；参附注射液治疗组（参附治疗组）在常规治疗组基础上加用参附注射液100 mL，以微量泵20 mL/h连续静脉泵入，每日2次，共7 d。观察治疗前及治疗后1、6、12、24、48、72 h血流动力学状态、乳酸水平及血管活性药使用情况、器官功能、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、序贯器官衰竭评分（SOFA评分）、脱离呼吸机时间、住重症加强治疗病房（ICU）时间、无器官衰竭时间、28 d病死率。结果与治疗前比较，两组治疗后平均动脉压（MAP）、心排血指数（CI）、外周血管阻力指数（SVRI）均升高，心率（HR）、乳酸水平均下降（均P＜0.05）。与常规治疗组比较，参附治疗组治疗后24 h MAP水平明显升高〔mmHg（1 mmHg＝0.133 kPa）：75.40±9.75比71.80±11.08，P＜0.05〕，持续到48 h；治疗后6 h CI水平明显升高（mL·s^-1·m^-2：75.18±34.84比67.35±39.34，P＜0.05），持续到48 h；治疗后6 h乳酸水平明显降低（mmol/L：2.03±0.82比2.24±0.97，P＜0.05）；两组血管活性药物用量比较差异均无统计学意义（均P＞0.05）。与治疗前比较，常规治疗组γ-谷氨酰转肽酶（GGT）治疗后1 d、3 d均升高，5 d开始降低，7 d时最低（U/L：26.75±16.74比46.96±25.85）；而参附治疗组治疗后1 d升高，3 d开始降低，7 d时最低（U/L：22.41±17.87比51.23±27.74）；天冬氨酸转氨酶（AST）、总胆红素（TBil）、氧合指数（PaO2/FiO2）治疗后1、3、5、7 d均升高，尿素氮（BUN）、肌酐（Cr）治疗后各时间点均降低。常规治疗组治疗后1、3、5 d�Objective To approach the effect of Shenfu injection （SFI） and conventional early goal-directed therapy （EGDT） on organ functions and outcomes of septic shock patients. Methods Eighty-four cases conformed to the criteria for the diagnosis of septic shock admitted to Department of Critical Care Medicine of Xuzhou Central Hospital were randomly divided into conventional treatment group （42 cases）, and SFI treatment group （42 cases）. Conventional treatment was given in the two groups;in SFI treatment group, SFI 100 mL was additionally given by trace continuous intravenous pump 20 mL/h, twice daily for 7 days. Before and after treatment for 1, 6, 12, 24, 48, 72 hours, the levels of hemodynamic status, lactic acid and dosage of vasoactive drugs used, organ function, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score, sequential organ failure assessment （SOFA） score, the time of weaning from ventilator, the length of stay in intensive care unit （ICU）, time without organ failure and 28-day mortality rate were observed. Results Compared with those before treatment, after treatment in the two groups, the mean arterial pressure （MAP）, cardiac index （CI） and systemic vascular resistance index （SVRI） were increased, while the levels of heart rate （HR） and lactate were decreased （all P〈0.05）. Compared with conventional treatment group, in SFI treatment group, after treatment for 24 hours, the MAP level was increased significantly [mmHg （1 mmHg=0.133 kPa）：75.40±9.75 vs. 71.80±11.08, P 〈 0.05], that continued to 48 hours; after treatment for 6 hours, the CI level was increased obviously （mL·s^-1·m^-2： 75.18±34.84 vs. 67.35±39.34, P 〈 0.05） , that continued to 48 hours; after treatment for 6 hours, the lactic acid level was decreased markedly （mmol/L： 2.03±0.82 vs. 2.24±0.97, P 〈 0.05）;in the comparison of dosage of vasoactive drugs used between two groups, the difference was not significant （all P 〉0.05）. Compared with tha

关 键 词：休克 感染性 参附注射液 血流动力学 器官功能 病死率 

分 类 号：R259.416.1[医药卫生—中西医结合]