温补肾阳法治疗脓毒症伴急性肾上腺皮质功能不全的疗效观察  

Effective observation of Nourishing and Warming Kidney-Yang Therapy on treating the septic shock with acute adrenocortical insufficiency

作　　者：苏梦达 李雅茜[1] 关良劲[1] 

机构地区：[1]天河区中医院,广东广州510655

出　　处：《中医临床研究》2017年第21期126-128,共3页Clinical Journal Of Chinese Medicine

摘　　要：目的:研究温补肾阳法脓毒症伴急性肾上腺皮质功能不全的临床疗效。方法:选择2011年3月-2015年3月天河区中医院ICU收治的脓毒症伴急性肾上腺皮质功能不全患者52例,采用随机数字表法将患者分为对照组和观察组,每组26例。对照组采用脓毒症常规方案及氢化可的松治疗,观察组在对照组的基础上,给予温补肾阳法治疗。观察两组患者的临床表现,采用休克复苏率、28 d存活率以评价疗效;放射免疫法检测治疗前后血清皮质醇浓度水平。结果:观察组患者3 d休克复苏率为69.23%,对照组则为30.77%,差异有统计学意义(P<0.05)。观察组患者1个月存活率为57.69%,对照组则为23.08%,差异有统计学意义(P<0.05)。治疗后,观察组患者平均动脉压明显高于对照组(69.83±16.32)mmHg vs(54.19±13.69)mmHg,差异有统计学意义(P<0.05);而观察组患者急性生理功能和慢性健康状况评分系统Ⅱ评分则明显低于对照组(15.19±10.38)分vs(24.51±12.48)分,差异有统计学意义(P<0.05)。此外,治疗后,观察组促肾上腺皮质激素兴奋试验后1h血清皮质醇浓度升幅水平明显高于对照组(261.37±106.24)nmol/L vs(123.74±89.25)nmol/L,差异有统计学意义(P<0.05)。结论:温补肾阳法可用于治疗脓毒症伴急性肾上腺皮质功能不全,其不仅能提高3 d休克复苏率以及1个月存活率,还可以显著改善患者血清皮质醇浓度水平。Objective:To investigate the clinical effect of nourishing and warming kidney-Yang therapy on treating the septic shock with acute adrenocortical insufficiency.Methods:52patients with septic shock and acute adrenocortical insufficiency from Tianhe traditional Chinese hospital from March2011from2015were divided into the control and the observation group by using random number table.Patients in the control group were treated with conventional treatment and hydrocortisone.And patients in the observation group were given the nourishing and warming kidney-Yang therapy on the basis of treatment of the control group.The clinical manifestations were observed as well as the recovery rate of shock and survival rate were used to evaluate the efficacy and the serum concentration of cortisol was tested by the radioimmunoassay.Results:The3-day recovery rate of shock in the observation group was69.23%while it was30.77%in the control group,and there was statistical difference(P<0.05).The1-month survival rate in the observation group was57.69%while it was23.08%in the control group;and there was statistical difference(P<0.05).After treatment,the mean arterial pressure in the observation group was much more than that of the control group(69.83±16.32)vs(54.19±13.69);and there was statistical difference(P<0.05).And the acute physiology and chronic health evaluationⅡin the observation group was significantly less than that of the control group(15.19±10.38)vs(24.51±12.48);and there was statistical difference(P<0.05).Moreover,after the medication,the serum concentration of cortisol after an hour of the adrenocorticotropic hormone stimulating test in the observation group increased much more significantly than that of the control group(261.37±106.24)vs(123.74±89.25);and there was statistical difference(P<0.05).Conclusion:Nourishing and warming kidney-yang therapy could be used in treating the septic shock with acute adrenocortical insufficiency.It could improve the3-day recovery rate of shock and the1-month survival rate as well

关 键 词：温补肾阳法 脓毒症 急性肾上腺皮质功能不全 

分 类 号：R278[医药卫生—中医学]