附子改善阳气亏虚型脓毒性休克患者心功能的作用  

Effect of aconite on improving cardiac function in patients with septic shock induced by Yang qi deficiency

作　　者：陶福正[1] 姜丹[2] 苏丽丽 陈仁辉[1] 王和浩 柳缨 TAO Fuzheng;JIANG Dan;SU Lili(Department of ICU,Taizhou Hospital of Integrated Chinese and Western Medi-cine,Taizhou 317523,China)

机构地区：[1]台州市中西医结合医院ICU,浙江台州317523 [2]台州市中西医结合医院急诊科,浙江台州317523 [3]台州市中西医结合医院心血管内科,浙江台州317523

出　　处：《全科医学临床与教育》2021年第8期692-696,共5页Clinical Education of General Practice

基　　金：浙江省中医药科学研究基金项目(2019ZB139)。

摘　　要：目的观察附子煎剂灌胃对阳气亏虚型脓毒性休克患者心功能的改善作用。方法选择阳气亏虚型脓毒性休克患者72例,随机分为干预组和对照组,各36例。两组均按2016国际脓毒症和感染性休克管理指南实施治疗,干预组在此基础上给予9 g附子煎剂灌胃,每6小时1次,共8次;对照组给予等量开水灌胃。观察两组患者入院时(0 h)、治疗后12 h、24 h、48 h的临床指标,包括平均动脉压(MAP)、血乳酸(Lac)、N末端B型脑钠肽前体(NT-ProBNP),以及超声监测指标:下腔静脉内径呼吸变异率(IVC-V)、每搏输出量(SV)、左室射血分数(LVEF)、左心室舒张早期最大血流/心房收缩期二尖瓣最大血流(E/A)、右心室面积变化分数(RVFAC),比较两组患者血管活性药物使用时间、ICU住院时间、28 d病死率以及不良反应。结果治疗后12 h,干预组患者的MAP高于对照组,差异有统计学意义(t=2.13,P<0.05),治疗后12 h、24 h、48 h,干预组血Lac、NT-ProBNP均低于对照组,差异均有统计学意义(t分别=2.50、2.80、3.84、4.96、11.05、25.58,P均<0.05)。治疗24 h后,干预组IVC-V大于对照组,差异有统计学意义(t=2.26,P<0.05)。治疗后24 h、48 h,干预组LVEF大于对照组,差异均有统计学意义(t分别=2.79、2.23,P均<0.05),治疗后12 h、24 h、48 h,干预组SV、E/A、RVFAC均大于对照组,差异均有统计学意义(t分别=2.01、3.29、3.64、7.86、2.77、4.87、2.86、2.13、2.49,P均<0.05)。干预组的血管活性药物使用时间、ICU住院时间均低于对照组,差异均有统计学意义(t分别=4.21、2.08,P均<0.05);但两组28 d病死率比较,差异均无统计学意义(χ2=1.15,P>0.05)。两组患者的不良反应发生率,包括肝肾功能、凝血功能、心律失常、TnI异常、肢端坏死、误吸等,差异均无统计学意义(χ2分别=0.07、0.22、0.56、0.00、1.01、0.16,P均>0.05)。结论附子煎剂灌胃可改善阳气亏虚型脓毒性休克患者的血流动力学参数和组织�Objective To observe the effect of aconite decoction on the improvement of cardiac function in patients with septic shock of Yang qi deficiency.Methods According to the inclusion and exclusion criteria,a total of 72 con-secutive patients with septic shock of Yang qi deficiency were admitted to ICU.They were randomized into the interven-tion group and the control group with 36 cases each.The patients were treated according to the 2016 international guide-lines for the management of sepsis and septic shock,and the intervention group was given 9 g aconite decoction by intra-gastric gavage,once every 6 hours,a total of 8 times.The control group was given the same amount of water by gavage.At the time of inclusion(0h),12h,24h and 48h after treatment,the mean arterial pressure(MAP),blood lactic acid(Lac),N terminal B-type natriuretic peptide(NT-ProBNP),as well as the ultrasonic monitoring indicators including vari-ation rate of inner diameter of inferior vena cava with respiration(IVC-V),stroke volume(SV),left ventricular ejection fraction(LVEF),early peak blood flow in mitral valve/atrial systolic blood flow peak(E/A),right ventricular fractional area change(RVFAC)were observed.The duration of use of va-soactive drugs,length of stay in ICU,28-day mortality,and adverse reactions were compared between the two groups.Re⁃sults The MAP in the intervention group was significantly higher than that in the control group at 12h after treatment(t=2.13,P<0.05).The Lac and NT-proBNP in the blood were significantly lower than those in the control group at 12h,24 h and 48h after treatment(t=2.50,2.80,3.84,4.96,11.05,25.58,P<0.05).The IVC-V of the intervention group was greater than that of the control group at 24h(t=2.26,P<0.05).The LVEF of the intervention group was greater than that of the control group at 24h and 48h(t=2.79,2.23,P<0.05).The SV,E/A and RVFAC were greater than those of the control group at 12h,24h and 48h(t=2.01,3.29,3.64,7.86,2.77,4.87,2.86,2.13,2.49,P<0.05).The duration of use of vasoac-tive drugs and the lengt

关 键 词：脓毒性休克 阳气亏虚 附子 心功能 

分 类 号：R278[医药卫生—中医学]