参附注射液改善脓毒症休克的疗效观察

目的观察参附注射液改善脓毒症休克的临床疗效。方法选取2014年10月—2016年3月天津中医药大学第一附属医院收治的脓毒症休克患者71例,所有患者按随机数字表法分为对照组(35例)和治疗组(36例)。对照组给予积极维持循环、机械通气、控制血糖、镇静等治疗。治疗组在对照组基础上静脉滴注参附注射液,100 m L加入5%葡萄糖250m L中,1次/d。两组均治疗7 d。观察并比较两组的中心静脉血氧饱和度(Sc VO2)、乳酸(Lac)、24 h乳酸清除率、氧输送量(DO2)、氧消耗量(VO2)、氧摄取率(O2ER%),序贯器官衰竭估计(SOFA)评分、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、重症监护室(ICU)住院时间和28 d死亡率。结果治疗后,两组Sc VO2和Lac均显著下降,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,治疗组24 h乳酸清除率明显高于对照组,两组比较差异有统计学意义(P0.05)。治疗后,两组DO2水平均明显上升,同组治疗前后比较差异有统计学意义(P0.05),而VO2和O2ER%改善不明显;且治疗组DO2水平明显高于对照组,两组比较差异具有统计学意义(P0.05)。两组SOFA评分和APACHEⅡ评分均明显降低(P0.05),同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标明显低于对照组,两组比较差异具有统计学意义(P0.05)。对照组和治疗组ICU住院时间比较差异无统计学意义。对照组和治疗组死亡率比较差异无统计学意义。结论参附注射液可改善脓毒症休克治疗,增加氧输送量,改善组织灌注状态,降低SOFA评分和APACHEⅡ评分,具有一定的临床推广应用价值。

Clinical observation of Shenfu Injection to improve septic shock

Objective To observe the clinical effect of Shenfu Injection to improve septic shock. Methods Patients (71 cases) with septic shock in First Teaching Hospital of Tianjin University of TCM from October 2014 to March 2016 were randomly divided into the control group (35 cases) and the treatment group (36 cases). Patients in the control group were given routine treatment, including maintaining circulation, mechanical ventilation, blood glucose control, sedation. Patients in the treatment group were iv administered with Shenfu Injection on the basis of the control group, 100 mL added into 5% glucose solution 250 mL, once daily. Patients in two groups were treated for 7 d. After treatment, ScVO2, Lac, 24 h lactic acid clearance rate, DO2, VO2, O2ER%, SOFA scores, APACHEⅡ scores, ICU hospitalization time, and 28 d mortality in two groups were compared. Results After treatment, ScVO2 and Lac in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the 24 h lactic acid clearance rate in the treatment group was higher than that in the control group, and there was difference between two groups (P < 0.05). After treatment, the DO2 levels in two groups were significantly increased, and the difference was statistically significant in the same group (P < 0.05), but VO2 and O2ER% had no difference. And the DO2 levels in the treatment group were significantly higher than that in the control group, with significant difference between two groups (P < 0.05). After treatment, SOFA scores and APACHEⅡ scores in two groups were significantly decreased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P < 0.05). There was no difference of ICU hospitalization time and mortality rate between two groups. Conclusion Shenfu Injection can improve septic shock therapy, increase oxygen delivery, improve tissue perfusion, and decrease SOFA scores and APACHEⅡ scores, which has a certain clinical application value.