回阳救逆综合疗法对脓毒症休克患者液体复苏及预后的影响研究  

Study on the effects of comprehensive therapy of reviving the Yang for resuscitation on fluid resuscitation and prognosis in patients with septic shock

作　　者：周智恩[1] 卢萍[1] 姚娟 杨梁 ZHOU Zhien;LU Ping;YAO Juan;YANG Liang(Chengdu Integrated TCM & Western Medicine Hospital/Chengdu First People’s Hospital, Chengdu 610017, Sichuan, China)

机构地区：[1]成都市中西医结合医院/成都市第一人民医院,四川成都610017

出　　处：《现代中西医结合杂志》2022年第11期1461-1465,共5页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：四川省医学会青年创新基金资助项目(川学会医字[2017]709号);四川省成都市中医重点专科(专病)建设项目(2020)。

摘　　要：目的探讨回阳救逆综合疗法对脓毒症休克患者液体复苏及预后的影响。方法选择2018年3月—2020年6月成都市第一人民医院重症医学科收治的脓毒症休克患者96例,随机分为对照组48例和治疗组48例。2组均予以脓毒症休克西医基础治疗,治疗组同时给予参附注射液静滴及足三里、关元穴电针治疗7 d。记录2组患者治疗前及治疗6 h、12 h、24 h后的平均动脉压(MAP)、中心静脉压(CVP)、中心静脉血氧饱和度[Scv(O_(2))]、血乳酸水平和尿量;比较2组治疗6 h、12 h、24 h后的乳酸清除率及治疗前和治疗7 d后急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯性器官衰竭(SOFA)评分、受损器官数目;记录2组患者机械通气时间、使用血管活性药物时间、早期目标指导性复苏治疗(EGDT)达标时间、ICU住院时间和28 d病死率。结果治疗6 h、12 h、24 h后,2组患者MAP、CVP、Scv(O_(2))和尿量均明显高于治疗前(P均<0.05),且治疗组治疗6 h后MAP、CVP、Scv(O_(2))、尿量及治疗24 h后MAP、CVP、尿量均明显高于同期对照组(P均<0.05);治疗6 h、12 h、24 h后,2组患者血清乳酸水平均明显低于治疗前(P均<0.05),且治疗组均明显低于同期对照组(P均<0.05);2组治疗12 h、24 h后乳酸清除率均明显高于治疗6 h后(P均<0.05),且治疗组治疗12 h乳酸清除率明显高于同期对照组(P均<0.05)。治疗组机械通气时间、使用血管活性药物时间、EGDT达标时间、ICU住院时间均显著短于对照组(P均<0.05),APACHEⅡ评分、SOFA评分均显著低于对照组(P均<0.05),受损器官数目显著少于对照组(P<0.05),2组治疗28 d病死率比较差异无统计学意义(P>0.05)。结论回阳救逆综合疗法可有效提高脓毒症休克患者液体复苏效果,改善组织灌注及预后。Objective It is to evaluate the effect of comprehensive therapy of reviving the Yang for resuscitation on fluid resuscitation and prognosis in patients with septic shock.Methods Ninety-six patients with septic shock treated in department of Intensive Care Unit(ICU)of Chengdu First People,s Hospital form March 2018 to June 2020 were selected and randomly divided into control group and treatment group with 48 cases in each group.Both groups were given basic western medicine treatment for septic shock,while the treatment group was treated with Shenfu injection by intravenous drip and electroacupuncture at Zusanli and Guanyuan points for 7 days.The mean arterial pressure(MAP),central venous pressure(CVP),central venous oxygen saturation[Scv(O_(2))],levels of serum lactate and urine volume of the patients in both groups before and at 6 h,12 h,24 h after treatment were recorded;the lactate clearance rate after treatment for 6 h,12 h,24 h,and the scores of acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),and the number of damaged organs before and after treatment for 6 h,12 h,and 24 h were compared between the two groups;the mechanical ventilation time,vasoactive drug use time,required time of early goal-guided resuscitation therapy(EGDT),ICU stay time and 28-day mortality were recorded in the two groups.Results After 6 h,12 h and 24 h of treatment,MAP,CVP,Scv(O_(2))and urine volume of the patients in the two groups were significantly higher than those before treatment(all P<0.05),and MAP,CVP,Scv(O_(2)),urine volume after 6 h of treatment and MAP,CVP and urine volume after 24 h of treatment in the treatment group were significantly higher than those in the control group at the same time(all P<0.05);after 6 h,12 h and 24 h of treatment,the levels of serum lactate of the patients in both groups were significantly lower than those before treatment(all P<0.05),and the level in the treatment group was significantly lower than that in the control group at the same time(all

关 键 词：脓毒症休克 回阳救逆法 液体复苏 预后 

分 类 号：R631[医药卫生—外科学]