摘要
目的 观察四逆汤对脓毒症患者下丘脑-垂体-肾上腺轴功能的影响.方法 采用前瞻性单盲随机对照研究,将60例脓毒症患者按随机数字编码法随机分为对照组（20例）、中药组（20例）、激素组（20例）.所有患者均给予常规治疗；中药组加用四逆汤[熟附子（先煎）15 g,干姜15 g,炙甘草10g],制成100 mL的煎剂,每日分2次温服或鼻饲；激素组加用氢化可的松200 mg/d静脉滴注,3组均治疗7d.分别于治疗前、治疗3d及治疗14 d时取血,测定促肾上腺皮质激素（ACTH）和皮质醇水平,并观察3组患者对ACTH刺激试验的反应；同时计算急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分,统计3d休克复苏率及28 d病死率.结果 3组患者对ACTH刺激试验差异无统计学意义（x2=1.101,P=0.605）.3组患者治疗后ACTH水平逐渐下降；与治疗前比较,中药组和激素组治疗3d时ACTH水平即明显下降（ng/L：29.90±3.31比33.10±3.31,28.20±2.45比33.30±3.84,均P＜0.01）,而对照组治疗14d时ACTH水平才明显下降（ng/L：29.40±5.63比33.50±4.89,P＜0.05）；但中药组与激素组治疗后ACTH水平比较差异无统计学意义（均P＞0.05）.对照组治疗前后皮质醇水平变化不明显；中药组和激素组皮质醇水平呈先上升后下降趋势,治疗3d时皮质醇水平均明显高于治疗前（μg/L：343.04±31.20比294.70±42.10,331.25±42.80比280.36±38.10,均P＜0.01）和对照组（μg/L：291.61±41.50,均P＜0.01）；但中药组与激素组治疗后皮质醇水平比较差异无统计学意义（均P＞0.05）.对照组、中药组和激素组治疗14 d APACHEⅡ评分均较治疗前明显下降（分：16.8±5.1比20.1±4.3,13.4±3.2比18.3±3.8,15.1±2.5比19.5±4.0,均P＜0.01）,且中药组较对照组下降显著（P＜0.05）.对照组、中药组和激素组在降低患者28 d病死率[35.0％（7/20）、25.0％（5/20）、20.0％（4/20）]、提高3d休克复苏率[40.0％（8/20）、70.0�
Objective To investigate the effects of Sini decoction on function of hypothalamic-pituitary-adrenal axis in patients with sepsis. Methods A prospective single-blind randomized controlled trial was conducted. 60 septic patients were divided into three groups with the method of random number table, 20 cases in the control group, 20 in the Chinese herb group, and 20 in corticoid group. All of them received routine treatment. Patients in Chinese herb group were given Sini decoction in addition （decoction of monkshood 15 g, dried ginger 15 g, honey-fried licorice 10 g） 100 mL/d orally or by nasal feeding, while patients in corticoid group were given hydrocortisone 200 mg/d intravenously instead, both for 7 days. Before the treatment, 3 days and 14 days after treatment, blood was collected to determine the levels of adrenocorticotropic hormone （ACTH） and cortisol, and the result of ACTH stimulating test was observed. At the same time, acute physiology and chronic health evaluation II （APACHE II ） score was recorded, and 3-day shock recovery rate and 28-day death rate were also compared among these groups. Results None of the three groups showed different result in ACTH stimulating test （XZ= 1.101, P= 0.605 ）. ACTH in three groups was gradually decreased. Compared with that before treatment, ACTH in Chinese herb group and corticoid groups began to decrease obviously on day 3 （ng/L： 29.90 ± 3.31 vs. 33.10 ± 3.31, 28.20 ± 2.45 vs. 33.30 ± 3.84, both P〈0.01 ）, while in control group declined ACTH appeared later （on day 14） compared with before treatment （ng/L： 29.40 ± 5.63 vs. 33.50±4.89, P〈0.05）. No obvious difference in ACTH level was showed between the Chinese herb group and the cortical group （both P〉0.05）. Cortisol level in both Chinese herb and cortical groups showed a raise-fall biphase trend while there was no change in the control. The cortical levels on day 3 in Chinese herb and cortical groups were much higher than that before treatment （ug/L： 343.04 ± 31.20
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2014年第3期184-187,共4页
Chinese Critical Care Medicine
基金
基金项目：广东省深圳市医药卫生科技计划项目（201202037）
