摘要
目的观察生脉注射液对不同类型休克患者血流动力学的影响，并分析其意义。方法36例休克患者中低血容量休克1l例，感染性休克15例，心源性休克10例。所有患者在积极治疗原发病和对症处理基础上静脉滴注生脉注射液100ml，每日1次，并以多巴胺或去甲肾上腺素维持平均动脉压（MAP）≥65mmHg（1mmHg=0．133kPa）。采用脉搏指示连续心排血量（PiCCO）监测技术监测治疗前及治疗后即刻、1h、6h时心率（HR）、有创动脉血压、中心静脉压（CVP）、心排血指数（CI）、胸腔内血容量指数（ITBVI）、外周血管阻力指数（SVRI）、血管外肺水（EVLW）等指标，分析各组患者血流动力学变化规律及其意义，并观察血管活性药物剂量的变化。结果生脉注射液在早期（给药后0～6h）对低血容量休克和心源性休克可以降低HR，对感染性休克无影响；迅速提升3类休克患者收缩压（SBP）；对舒张压（DBP）影响不大；对低血容量休克和心源性休克在早期持续升高MAP，对感染性休克无影响；对3类休克CVP均无影响；对3类休克有明显提高cI的功效；改善感染性休克和心源性休克患者ITBVI，对低血容量休克患者也有短时间升高ITBVI的作用；对低血容量休克和心源性休克患者可以降低SVRI，升高感染性休克患者SVRI；可以降低感染性休克和心源性休克患者EvLw；减少3类休克患者血管活性药物的剂量，具有缩短使用血管活性药物时间的可能。结论生脉注射液对低血容量休克、感染性休克和心源性休克早期均有不同程度抗休克作用，但在改善临床指标与血流动力学指标方面3者有所不同。
Objective To observe the effects of Shengmai injection （生脉注射液） on the hemodynamics in patients with different types of shock and to analyze its significance. Methods Thirty-six cases with shock were separated into three groups： hemorrhagic shock （HS） group （11 cases）, septic shock （SS） group （15 cases） and cardiogenic shock （CS） group （10 cases）. Patients with active treatments for primary diseases and symptoms were infused intravenously with 100 ml of Shengmai injection once per day, and their mean artery pressure （MAP） was maintained at ≥65 mm Hg （1 mm Hg= 0.133 kPa） with dopamine or nor-epinephrine. Before treatment and 0, 1, 6 hours after treatment, the heart rate （HR）, invasive artery blood pressure, central venous pressure （CVP）, cardiac index （CI）, intra-thoraeic blood volume index （ITBVI）, systemic vascular resistance index （SVRI） and extra-vascular lung water （EVLW） and other indexes were determined by the pulse-indicated continuous cardiac output （PiCCO）. The regularity and significance of changes in hemodynamics were analyzed, and the dose changes of dopamine or nor-epinephrine were recorded in all groups. Results HR was depressed in HS group and CS group after infusion of Shengmai injection in early period （0 6 hours after administration）, but there was no such effect in SS group. The systolic blood pressure （SBP） and CI in the three groups were quickly elevated after infusion, but their diastolic blood pressures （DBP） and CVPs were of no significant change. The levels of MAP were kept on elevating at early period after infusion with Shengmai injection in HS and CS groups, but such change was not seen in SS group. It could improve ITBVI in SS group and CS group, and also could heighten ITBVI in HS group for a short time. After the administration, the SVRI was lowered in HS group and CS group, but contrarily,SVRI was elevated in SS group, and EVLW could be also decreased in SS group and CS group. The doses of dopa
出处
《中国中西医结合急救杂志》
CAS
北大核心
2011年第1期21-24,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
基金项目：广东省珠海市医药卫生科研项目（2010025）
