参附注射液联合高容量血液滤过对脓毒症诱发急性呼吸窘迫综合症患者的治疗效果及血清Ang-2、SP-D水平的影响  

Therapeutic Effect of Shenfu Injection Combined with High-volume Hemofiltration for Patients with Sepsis-induced Acute Respiratory Distress Syndrome and Its Effect on Serum Angiopoietin 2 and Alveolar Surfactant Protein D

作　　者：李喆 刘金华 何龙培 蔡茜 朱应群 LI Zhe;LIU Jin-Hua;HE Long-Pei;CAI Qian;ZHU Ying-Qun(Dept.of Respiratory and Critical Care Medicine,Changsha Third Hospital,Changsha 410015 Hunan,China)

机构地区：[1]长沙市第三医院呼吸与危重症学科,湖南长沙410015

出　　处：《广州中医药大学学报》2022年第10期2249-2255,共7页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：国家自然科学基金项目(编号:81701962)。

摘　　要：【目的】研究参附注射液联合高容量血液滤过对脓毒症诱发的急性呼吸窘迫综合症(ARDS)患者肺功能以及血清中血管生成素2(Ang-2)和肺泡表面活性蛋白D(SP-D)水平的影响。【方法】将60例脓毒症诱发的ARDS患者随机分为对照组和观察组,每组各30例。对照组患者给予镇静药物和胃肠动力药物、肠内及肠外营养、合理应用的抗菌药物、机械通气(PB840呼吸机)和高容量血液滤过治疗,观察组患者在对照组的基础上配合参附注射液静脉泵入治疗,疗程为7 d。比较2组患者的ICU住院时间和机械通气时间,观察2组患者治疗前后临床症状、体征变化,以及血气分析指标、血流动力学参数、血清白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、Ang-2和SP-D水平的变化情况。【结果】(1)血气分析方面,治疗后,2组患者的动脉血氧分压(PaO)、二氧化碳分压(PaCO)和氧合指数(PaO/FiO)均较治疗前改善(P<0.05),且观察组对PaO、PaCO和PaO/FiO的改善作用均明显优于对照组(P<0.01)。(2)ICU住院时间和机械通气时间方面,观察组患者的机械通气时间和ICU住院时间均较对照组明显缩短(P<0.05或P<0.01)。(3)临床症状、体征变化方面,治疗后,2组患者的呼吸窘迫症状均有所缓解,双肺的湿罗音均有所减少,氧合功能均明显改善,胸部X射线检查发现患者斑片状阴影逐渐消散。其中,观察组的改善情况优于对照组,且具有较快的改善速率。(4)血流动力学参数方面,治疗后,2组患者的心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)均较治疗前明显改善(P<0.05),且观察组对HR、MAP和CVP的改善作用均有优于对照组趋势,但差异均无统计学意义(P>0.05)。(5)炎症因子方面,治疗4 d后,2组患者血清IL-6、TNF-α、Ang-2和SP-D水平均较治疗前有所改善(P<0.05),且观察组对血清Ang-2和SP-D水平的改善作用均优于对照组(P<0.05);治疗7 d后,2组患者血清IL-6、TNF-α、Ang-2和SObjective To investigate the effects of Shenfu Injection combined with high-volume hemofiltration on lung function and serum angiopoietin 2(Ang-2)and alveolar surfactant protein D(SP-D)of patients with sepsisinduced acute respiratory distress syndrome(ARDS).Methods Sixty patients with sepsis-induced ARDS were randomly divided into the control group and the observation group,with 30 cases in each group.The patients in the control group were given sedative and gastrointestinal motility drugs,enteral and parenteral nutrition,reasonable application of antibacterial drugs,mechanical ventilation(ventilator-PB840)and high-volume hemofiltration treatment,while the patients in the observation group were treated with intravenous pumping of Shenfu Injection on the basis of treatment for the control group.The treatment for both groups lasted 7 days.The time of ICU stay and time of mechanical ventilation in the two groups were compared.Meanwhile,we observed the changes in the clinical symptoms and signs,as well as the changes in blood gas analysis and hemodynamic parameters,and serum interleukin 6(IL-6),tumor necrosis factorα(TNF-α),Ang-2 and SP-D levels in the two groups.Results(1)The results of blood gas analysis showed that after treatment,the arterial blood partial pressure of oxygen(PaO),partial pressure of carbon dioxide(PaCO)and oxygenation index(PaO/FiO)in both groups were improved compared with those before treatment(P<0.05),and the effect on improving PaO,PaCOand PaO/FiOin the observation group was significantly superior to that in the control group(P<0.01).(2)Both of the time of mechanical ventilation and the time of ICU stay in the observation group were significantly shortened compared with those in the control group(P<0.05 or P<0.01).(3)After treatment,the respiratory distress symptoms of both groups were relieved,the wet rales in both lungs were reduced,the oxygenation function was significantly improved,and the patchy shadows showed by the chest X-ray imaging were gradually dissipated.And the improvement in

关 键 词：参附注射液 脓毒症 急性呼吸窘迫综合症 肺功能 血管生成素2(Ang-2) 肺泡表面活性蛋白D(SP-D) 

分 类 号：R259.638[医药卫生—中西医结合]