摘要
目的观察四逆升降散对改善脓毒症毛细血管渗漏综合征患者无创血流动力学指标的效果。方法将92例受试者随机分为对照组和治疗组,每组46例。在常规治疗基础上治疗组加用四逆升降散,对照组加用四逆升降散安慰剂,2组均治疗7 d。比较2组治疗前(T_(0))、治疗第3天(T_(1))、治疗第7天(T_(2))受试者胸液水平(TFC),以及心输出量(CO)、心脏指数(CI)、每搏输出量(SV)、每搏指数(SI)、每搏输出量变异度(SVV)、外周血管阻力(SVR)、外周血管阻力指数(SVRI)。记录急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)、序贯器官衰竭估计(SOFA)评分、中医证候评分。同时,比较2组连续肾脏替代治疗(CRRT)使用率、28 d病死率和住院时间。结果治疗组T_(1)和T_(2)时点CO、CI、SV、SI与对照组比较,差异有统计学意义(P<0.05)。治疗组T_(2)时点SVV、SVR、SVRI与对照组比较,差异有统计学意义(P<0.05)。治疗组T_(2)时点APACHEⅡ评分、SOFA评分、中医证候评分与T_(1)时点及对照组比较,差异有统计学意义(P<0.05)。治疗组CRRT使用率、28 d病死率低于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05)。结论无创血流动力学可用于脓毒症毛细血管渗漏综合征的临床疗效评估。四逆升降散可以降低胸液水平,增强心脏泵功能,减轻患者体内液体负荷,从而稳定患者血流动力学状态,改善脓毒症毛细血管渗漏综合征患者的预后。
Objective To observe the effect of Sini Shengjiang Powder in improving non-invasive hemodynamic indexes of sepsis capillary leakage syndrome.Methods A total of 92 subjects were randomly divided into control group and treatment group,with 46 cases in each group.The treatment group was treated with Sini Shengjiang Powder on the basis of conventional treatment,and the control group was additionally treated with placebo of Sini Shengjiang Powder.The treatment lasted for 7 days.Thoracic fluid content(TFC),cardiac output(CO),cardiac index(CI),stroke volume(SV),stroke index(SI),stroke volume variation(SVV),systemic vascular resistance(SVR),systemic vascular resistance index(SVRI)before treatment(T_(0)),on the third day(T_(1))and seventh day(T_(2))were compared.Acute physiology and chronic health scoreⅡ(APACHEⅡ),sequential organ failure score(SOFA)and TCM syndrome score were recorded between the two groups.The use rate of continuous renal replacement therapy(CRRT),28 day mortality and hospital stay were compared between the two groups.Results There were significant differences in CO,CI,SV and SI at T_(1) and T_(2) between the treatment group and the control group(P<0.05).There were statistically significant differences in SVV,SVR and SVRI at T_(2) between the treatment group and the control group(P<0.05).The APACHEⅡscore,SOFA score and TCM syndrome score at T_(2) of the treatment group showed significant differences when compared with T_(1) and the control group(P<0.05).The use rate of CRRT,28-day fatality rate in the treatment group were lower,and length of hospital stay was shorter than those in the control group(P<0.05).Conclusion Non-invasive hemodynamics can be used to evaluate the clinical efficacy of septic capillary leakage syndrome.Sini Shengjiang Powder can reduce the level of pleural fluid,enhance the function of heart pump,and reduce the fluid load in patients,so as to stabilize the hemodynamic state and improve the prognosis of patients with sepsis capillary leakage syndrome.
作者
沈梦雯
林柏柏
钱义明
赵雷
朱亮
钱风华
SHEN Mengwen;LIN Baibai;QIAN Yiming;ZHAO Lei;ZHU Liang;QIAN Fenghua(Department of Emergency Medicine,Yueyang Integrated Traditional Chinese and Western Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai,200437;Yueyang Clinical Medical College of Shanghai University of Traditional Chinese Medicine,Shanghai,201203)
出处
《实用临床医药杂志》
CAS
2021年第14期15-19,共5页
Journal of Clinical Medicine in Practice
基金
上海市卫生健康委员会、上海市中医药管理局中医专项培育项目(04.YY021.16)
上海市卫健委卫生行业临床研究专项(201940205)
上海中医药大学附属岳阳中西医结合医院青年基金资助项目(2019YYQ07)。
关键词
脓毒症
毛细血管渗漏综合征
中药
血流动力学
四逆升降散
sepsis
capillary leakage syndrome
traditional Chinese medicine
hemodynamics
Sini Shengjiang Powder
