活血逐瘀清毒汤预防脓毒症相关性急性肾损伤  

Prevention of Sepsis-related Acute Kidney Injury with Huoxue Zhuyu Qingdu Decoction

作　　者：王斌[1] 马娉娉 厉兆春 WANG Bin;MA Pingping;LI Zhaochun(Weifang Hospital of Traditional Chinese Medicine,Weifang Shandong China 261000)

机构地区：[1]潍坊市中医院,山东潍坊261000

出　　处：《中医学报》2022年第9期1988-1993,共6页Acta Chinese Medicine

基　　金：潍坊市卫生健康委员会中医药科研项目计划(2020-4-033)。

摘　　要：目的:观察活血逐瘀清毒汤预防脓毒症相关性急性肾损伤(sepsis related acute kidney injury,SAKI)的临床疗效。方法:84例患者随机分为对照组(43例)与观察组(41例)。对照组给予常规治疗,观察组在对照组治疗基础上给予活血逐瘀清毒汤,两组均治疗7 d。比较两组患者全身性感染相关性器官功能衰竭(sepsis related organ failure assessment,SOFA)评分、急性生理与慢性健康(acute physiology and chronic health evaluation,APACHEⅡ)评分,炎症因子、内皮细胞标志物水平,SAKI发生率。结果:两组患者APACHEⅡ评分、SOFA评分在治疗第3天时均高于治疗前(均P<0.05),治疗第7天时均显著低于第3天(P<0.05);治疗第3天、7天,观察组以上指标均低于同期对照组(P<0.05)。两组患者血肌酐(serum creatinine,Scr)、胱抑素C(cystatin C,CYS-C)水平在治疗第3天时均高于治疗前(均P<0.05),治疗第7天时均显著低于第3天(P<0.05);治疗第3天、7天,观察组以上指标均低于同期对照组(P<0.05)。两组患者肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-18(interleukin-18,IL-18)在治疗第3天时均低于治疗前(P<0.05),治疗7天显著低于第3天(P<0.05);治疗第3天、7天,观察组以上指标均低于对照组(P<0.05);治疗第3天,观察组血管性血友病因子(von willebrand factor,vwF)、可溶性血栓调节蛋白(soluble thrombmodulin,sTM)、内皮素-1(endothelin-1,ET-1)水平与治疗前比较,差异无统计学意义(P>0.05);对照组vwF、sTM、ET-1水平显著高于治疗前(P<0.05);治疗第7天,观察组vwF、sTM、ET-1水平显著低于同期对照组(均P<0.05);两组患者以上指标均低于第3天(P<0.05)。观察组SAKI发生率为20.0%(8/40),对照组为45.0%(18/40),两组比较,差异有统计学意义(P<0.05)。结论:活血逐瘀清毒汤可降低SAKI患者的APACHEⅡ评分、SOFA评分,改善肾功能,并通过改善炎症反应、保护内皮功能,预防SAKI的发生。Objective:To observe the clinical efficacy of Huoxue Zhuyu Qingdu Decoction in preventing sepsis related acute kidney injury(SAKI).Methods:84 patients were randomly divided into control group and observation group.The control group was given routine treatment,and the observation group was given Huoxue Zhuyu Qingdu Decoction on the basis of the treatment of the control group.Both groups were treated for 7 days.The acute physiology and chronic health evaluation(APACHE II)score,systemic infection-related organ failure assessment(SOFA)score,inflammatory factors and endothelial cell marker levels were compared between the two groups before and after treatment.SAKI incidence.Results:The acute physiology and chronic health evaluation(APACHE II)score and systemic infection-related organ failure assessment(SOFA)score of the two groups were higher than those before treatment on the third day of treatment(P<0.05),the 7th day of treatment was significantly lower than that of the 3rd day(P<0.05);on the 3rd and 7th day of treatment,the above indexes in the observation group were lower than those in the control group at the same period(P<0.05).Serum creatinine(Scr)and cystatin C(CYS-C)levels in the two groups were higher than those before treatment on the 3rd day of treatment(all P<0.05),and were significantly lower than those before treatment on the 7th day of treatment On the 3rd day(P<0.05);on the 3rd and 7th days of treatment,the above indexes in the observation group were lower than those in the control group at the same period(P<0.05).The levels of tumor necrosis factor-α(TNF-α)and interleukin-18(IL-18)in the two groups were lower than those before treatment on the third day of treatment(P<0.05).The 7th day of treatment was significantly lower than that of the 3rd day(P<0.05);on the 3rd and 7th day of treatment,the above indexes in the observation group were lower than those in the control group at the same period(P<0.05).On the third day of treatment,the levels of von Willebrand factor(vwF),soluble thrombmodulin(sTM),a

关 键 词：脓毒症 活血逐瘀清毒汤 急性肾损伤 炎症反应 内皮功能 

分 类 号：R277.592[医药卫生—中医学]