益气活血法联合连续性血液净化治疗危重病患者23例临床观察

目的 观察益气活血法联合连续性血液净化(CBP)治疗危重病患者的临床疗效.方法 将40例危重症中医辨证为气虚血瘀证患者随机分为对照组(17例)与治疗组(23例),对照组采用连续性静脉-静脉血液滤过(CVVH)方式治疗,治疗组在对照组基础上给予参麦注射液及丹参粉针治疗,观察两组治疗前后中医证候积分、急性生理学与慢性健康状况评分Ⅱ(APACHE-Ⅱ)、凝血指标、肝素总量、平均血压(MBP)、血气分析、肾功能、细胞因子水平及中医证候疗效.结果 治疗组治疗后血小板(PLT)、肝素总量、MBP均明显下降(P＜0.05),且两组治疗后PLT、肝素总量差异均有统计学意义(P＜0.05)；两组治疗后APACHE-Ⅱ、中医证候积分均较治疗前明显降低(P＜0.05),治疗组治疗后中医证候积分较对照组明显降低(P＜0.05).两组治疗后血气分析指标均较治疗前明显降低(P＜0.05).两组治疗后血尿素氮、肌酐及细胞因子水平均较治疗前明显降低(P＜0.05),但组间差异无统计学意义(P＞0.05).治疗组中医证候疗效总有效率明显优于对照组(P＜0.05). 结论 中医益气活血法联合CBP对危重症气虚血瘀证患者有较好的临床疗效,在改善患者中医证候积分、减少肝素用量方面优于单纯CBP治疗.

Clinical Study on Qi-Boosting Blood-Quickening Therapy Combined with C ontinuous Blood Purification for 40 Critically-ill Patients

Objective To observe the therapeutic effect of qi-b o osting blood-quickening therapy combined with continuous blood purification(CB P) for critically il l patients.Methods Forty critically-ill patients with qi-deficiency blood-stasis syndrome were randomized into control group of 17 c ases and treatment group of 23 cases.The control group was treated with continu ous venovenous hemodiaf iltration(CVVH) and the treatment group was added with qi-boosting blood-quic kening therapy.The scores of Chinese medical s yndromes,acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ),coagulation indicators,heparin total,mean blood pressure(MBP),blood gas anal ysis indexes,renal function,levels of cytokines and efficacy of Chinese medica l syndromes were observed.Results The heparin total in the control group decreased sig nificantly after treatmen t(P<0.05).The platelet(PLT),heparin total and MBP in t he treatment group decreased significantly after treatment(P<0.05),with s ign ificant difference in PLT and heparin total between groups(P<0.05).The sc ores of APACHE Ⅱ and Chinese medical syndromes decreased significantly in both group s after treatment,especially in scores of Chinese medical syndromes in the trea tment group(P<0.05).The blood gas analysis indexes decreased si gnificantly in both groups after treatment(P<0.05).Blood urea nitrogen(B UN),serum creatinine(Scr),tumor necrosis factor-α(TNF-α) and interleukin-6(IL-6) decreased significantly in both groups after treatment(P<0.05),with no significant difference betwe en g roups(P>0.05).The total effective rate of the treatment group(65.2%) wa s superior to that of the control group(52.9%,P<0.05).Conclusion Qi-boosting blood-quickening therapy combined with CBP is effective for critic ally ill patients with qi-deficiency blood-stasis syndrome,which is superior to simple CBP in improving scores of Chin ese medical syndromes and reducing the dosage of heparin.