参麦注射液联合复方氯化钠注射液液体复苏对创伤性休克患者心脏指数、血管外肺水指数及血乳酸水平的影响  

Effects of Shenmai injection combined with compound sodium chloride injection fluid resuscitation on cardiac index,extravascular lung water index and blood lactate level in patients with traumatic shock

作　　者：吴琪 朱保锋 储鑫 顾鹏 陈建荣 WU Qi;ZHU Baofeng;CHU Xin;GU Peng;CHEN Jianrong(Department of Emergency,Second Affiliated Hospital of Nantong University(Nantong First People's Hospital),Nantong,Jiangsu 226001)

机构地区：[1]南通大学第二附属医院(南通市第一人民医院)急诊科,江苏南通226001

出　　处：《河北中医》2022年第5期793-796,800,共5页Hebei Journal of Traditional Chinese Medicine

基　　金：南通市科技计划项目(编号:HS2018002)。

摘　　要：目的观察参麦注射液联合复方氯化钠注射液液体复苏对创伤性休克患者心脏指数(CI)、血管外肺水指数(EVLWI)及血乳酸(LA)水平的影响。方法选取2019年5月至2022年1月南通大学第二附属医院急诊科重症监护病房(ICU)创伤性休克患者89例,采用随机数字表法分为2组。对照组44例在脉波指示剂连续心排血量(PiCCO)监测技术指导下给予限制性液体复苏,观察组45例对照组治疗基础上加用参麦注射液治疗。比较2组治疗前及治疗48 h后CI、EVLWI、凝血功能指标、外周血辅助性T淋巴细胞17(Th17)、调节性T淋巴细胞(Treg)及血清LA、一氧化氮(NO)水平,记录住院期间患者的结局。结果2组治疗前CI、EVLWI、外周血Th17、Treg、NO、LA比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后CI、EVLWI及血清NO升高(P<0.05),外周血Th17、Treg和血清LA降低(P<0.05),且观察组治疗后CI、EVLWI、NO高于对照组,Th17、Treg及血清LA低于对照组(P<0.05)。2组治疗前凝血功能指标比较差异无统计学意义(P>0.05)。与本组治疗前比较,对照组治疗后凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)升高(P<0.05),国际标准化比值(INR)、纤维蛋白原(Fib)降低(P<0.05),观察组治疗后Fib升高(P<0.05),除Fib外的其他指标比较差异无统计学意义(P>0.05),且观察组治疗后INR、Fib高于对照组(P<0.05),PT、APTT低于对照组(P<0.05)。住院期间,对照组多器官功能障碍综合征(MODS)、急性呼吸窘迫综合征(ARDS)和死亡发生率分别为6.82%(3/44)、9.09%(4/44)和4.55%(2/44),观察组分别为4.44%(2/45)、2.22%(1/45)和0例,2组整体结局比较差异无统计学意义(P>0.05)。结论参麦注射液联合复方氯化钠注射液液体复苏可稳定创伤性休克患者的凝血功能,改善CI、EVLWI水平,提高机体免疫功能。Objective To observe the effects of Shenmai injection combined with compound sodium chloride injection fluid resuscitation on cardiac index(CI),extravascular lung water index(EVLWI)and blood lactate(LA)levels in patients with traumatic shock.Methods A total of 89 patients with traumatic shock in the Intensive Care Unit of the Emergency Department of the Second Affiliated Hospital of Nantong University from May 2019 to January 2022 were selected and divided into 2 groups by random number table method.The 44 cases in the control group were given restricted fluid resuscitation under the guidance of pulse wave indicator continuous cardiac output monitoring(PiCCO)technology,and the 45 cases in the observation group were treated with Shenmai injection on the basis of the treatment in the control group.The CI,EVLWI,coagulation function indexes,peripheral blood T helper 17(Th17),regulatory T cell(Treg)ratio,serum LA and nitric oxide(NO)levels were compared between the two groups before and after treatment,and the outcomes of the patients during hospitalization were recorded.Results Before treatment,there were no significant differences in CI,EVLWI,peripheral blood Th17,Treg ratio,NO,and LA between groups in shock patients(P>0.05).After treatment,CI,EVLWI and serum NO in shock patients in the two groups were higher than those before treatment.Peripheral blood Th17,Treg ratio and serum LA acid were lower than those before treatment,and the improvement of CI,EVLWI,peripheral blood Th17,Treg ratio,NO,LA in the observation group were higher than those in the control group(P<0.05).Before treatment,there was no significant difference in coagulation function indexes between the two groups(P>0.05).After treatment,the prothrombin time(PT)and activated partial thromboplastin time(APTT)in the control group were higher than those before treatment(P<0.05),the international normalized ratio(INR)and fibrinogen(Fib)were lower than those before treatment(P<0.05),and the Fib in the observation group was higher than that before treatment(P<

关 键 词：注射剂 休克 创伤性 乳酸 

分 类 号：R605.971.058[医药卫生—急诊医学] R654[医药卫生—外科学]