参芪扶正注射液联和血必净对脓毒性休克患者早期复苏及氧代谢的影响

目的探究参芪扶正注射液联合血必净对脓毒性休克患者液体复苏的干预作用及氧代谢的影响.方法选取2016年8月至2018年10月承德市中心医院急诊科收治的64例脓毒性休克患者,随机分为联合治疗组、参芪扶正注射液组、血必净组和对照组(每组各16例).四组患者进行目标导向性治疗(EGDT),对照组仅给0.9%氯化钠注射液和白蛋白液体复苏,必要时使用多巴酚丁胺或去甲肾上腺素升压;联合治疗组在对照组基础上早期加用参芪扶正注射液(250 mL/d)联合血必净(50 mL血必净加0.9%氯化钠注射液100 mL,200 mL/d),参芪扶正注射组和血必净注射液组是在对照组的基础上早期只加参芪扶正注射液(250 mL/d)或血必净(50 mL血必净加0.9%氯化钠注射液100 mL,200 mL/d)进行液体复苏.观察四组患者达到EGDT目标所需要的液体量、复苏完成时间、血管活性药物种类及剂量,以及氧代谢指标变化情况、并发症发生率和28 d病死率.结果四组患者EGDT时,联合治疗组复苏液体量、所需的多巴酚丁胺剂量及去甲肾上腺素均明显少于其他三组(均P<0.05),而四组复苏时间差异无统计学意义(P>0.05).联合治疗组试验过程中1例发生急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS),3例死亡;参芪扶正注射组和血必净注射液组试验过程中发生ARDS均为2例,3例死亡;对照组试验过程中4例发生ARDS,3例死亡,而病死率差异无统计学意义(P>0.05).联合治疗组、参芪扶正注射液组和血必净注射液组自复苏后24 h起氧输送(DO2)、中心静脉血氧饱和度(ScvO2)明显上升,而VO2、O2ER明显下降,均较复苏前明显改善(均P<0.05),而对照组多数指标在复苏后48 h才有明显变化,且联合治疗组的改善程度明显优于其他三组(P<0.05).结论参芪扶正注射液联合血必净能更早帮助脓毒性休克患者脱离休克状态,降低并发症的发生风险,改善体内氧代谢,是脓毒性休克患者较理想的复苏液体.

Effect of Shenqi Fuzheng injection on early recovery and oxygen metabolism in the patients with septic shock

Objective To study the effect of Shenqi Fuzheng injection combined with Xuebijing on early resuscitation and oxygen metabolism in the patients with septic shock.Methods From August 2016 to October 2018,64 patients with septic shock were randomly divided into four groups:combined therapy group,only Shengqi Fuzheng injection group,only Xuebijing injection group,control group(16 cases in each group).Four groups of patients received early goal-directed therapy(EGDT),control group was only given 0.9%sodium chloride injection and albumin liquid resuscitation,if necessary,dobutamine or norepinephrine increased pressure;The combined therapy group was treated early with Shenfu injection(250 mL/d)and Xuebijing injection(50 mL Xuebijing plus 9.0%sodium chloride injection 100 mL,200 mL/d)for liquid resuscitation on the basis of the control group;the other two therapeutic groups were treated with only Shengqi Fuzheng or Xuebijing based on the control group.To observe the amount of liquid,recovery completion tim e,type and dose of vascular active drugs,changes of oxygen metabolism index,the incidence of complications and mortality rate of 28 days.Results The volume of resuscitation fluid,the dose of dobutamine and norepinephrine in the combined therapy group were significantly lower than those in other three groups(P<0.05),but there was no significant difference in the resuscitation time among the four groups(P>0.05).The number of patient who had developed acute respiratory distress syndrome(ARDS)and died in the four groups were as follow:1 ARDS and 3 died in the combined therapy group,only 2 ARDS and 3 died in the Shengqi Fuzheng group or Xuebijing group,4 ARDS and 3 died in the control group,and there was no significant difference in mortality rate among four groups(P>0.05).In the experimental group,D 02 and S cv02 increased significantly from 24 h after resuscitation,while V 02 and 02ER decreased significantly.All improved significantly compared with pre-resuscitation(both P<0.05),while most of the indexes in the control group changed significantly at 48 h after resuscitation,and the improvement degree of the experimental group was obviously better than that of other three groups(P<0.05).Conclusion Shenqi Fuzheng injection combined with Xuebijing able to help the patients with septic shock escape from the state of shock earlier,reduce the risk of complications,and improve the bodys oxygen metabolism.It is an ideal resuscitation liquid for the patients with septic shock.