复苏合剂对感染性休克血流动力学影响的研究

A study on effect of resuscitation mixture on haemodynamics in patients with septic shock

目的 探讨复苏合剂对感染性休克患者血流动力学的影响.方法 选择2007年8月至2009年8月本院重症监护病房（ICU）收治的21例感染性休克患者,以入选时年龄单双数随机分为中药治疗组（11例）和对照组（10例）.对照组给予内科基础治疗;治疗组在对照组基础上加用复苏合剂（药物组成：附子30 g、生牡蛎30 g、干姜15 g、麻黄15 g、炙甘草10 g）25 ml鼻饲,每日4次,连用3 d.监测两组患者纳入时[中心静脉压（CVP）≥8 mm Hg（1 mm Hg=0.133 kPa）,T0]及纳入后24、48、72 h（T24、T48、T72）时的CVP、心排血指数（CI）、血管外肺水指数（EVLWI）、外周血管阻力指数（SVRI）、全心舒张期末容积指数（GEDVI）等血流动力学指标的变化,并记录28 d病死率.结果 与对照组比较,治疗组T0、T24、T48、T72时CI、GEDVI明显增加[CI（L·min-1·m-2）T0：3.96±1.48比2.73±0.63,T24：4.07±2.18比2.68±0.42,T48：3.73±1.42比2.64±0.47,T72：4.09±0.95比2.99±0.51;GEDVI（ml/m2）T0：838.36±166.07比599.30±206.68,T24：828.91±212.81比554.60±102.28,T48：802.09±187.63比574.10±134.36,T72：712.27±170.30比575.20±102.17],EVLWI（ml/m2）明显降低（T0：5.83±1.76比10.20±3.15,T24：7.31±1.45比10.12±3.15,T48：6.85±2.27比9.99±1.79,T72：5.45±1.68比7.91±3.33,P＜0.05或P＜0.01）;而两组各时间点CVP、SVRI比较差异无统计学意义（均P＞0.05）.治疗组28 d病死率低于对照组（45.6%比80.0%）,但差异无统计学意义（P〉0.05）.结论 复苏合剂可以明显增加感染性休克患者的CI、GEDVI,降低EVLWI,而对CVP、SVRI、28 d病死率影响不明显.

Objective To investigate the effect of resuscitation mixture on haemodynamics in patients with septic shock. Methods Twenty-one patients with septic shock admitted from August 2007 to August 2009 in Intensive Care Unit of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine were randomly divided into treatment group （11 cases） and control group （10 cases） by age odd and even number. Both groups were given basic medical treatment. The treatment group additionally received the resuscitation mixture [drugs： Aconite root （附子） 30 g, Raw oysters shell （生牡蛎） 30 g, Dried ginger （干姜） 15 g, Ephedra （麻黄） 15 g, Baked licorice （炙甘草） 10 g] 25 ml nasal feeding, 4 times daily for 3 days. After treat- ment central venous pressure （CVP）≥ 8 mm Hg （1 mm Hg=0. 133 kPa） as monitor starting time spot （TO）. Repeated haemodynamic measurements were done at baseline （TO）then at 24, 48 and 72 hours （T24, T48, T72）. CVP, cardiac index （CI）, extravascular lung water index （EVLWI）, systemic vascular resistance index （SVRI）, global end-diastolic volume index （GEDVI） were determined at each time point. And the 28-day mortality was recorded. Results Compared with the control group, CI and GEDVI were increased significantly, and EVLWI was declined obviously at TO, T24, T48 and T72 in the treatment group [CI （L· min-1 ·m-2） TO： 3. 965=1.48 vs. 2.73±0.63, T24： 4. 075=2.18 vs. 2. 68±0. 42, T48：3.73±1.42 vs. 2.64±0.47, T72：4.09±0.95 vs. 2.99±0.51; GEDVI （ml/m2） T0： 838. 365=166.07 vs. 599.30±206.68, T24.. 828.91±212.81 vs. 554.60±102.28, T48：802.095±187.63 vs. 574.105=134. 36, T72： 712.275= 170.30vs. 575. 205=102.17; EVLWI （ml/m2） TO： 5.835=1.76 vs. 10.20=t=3.15, T24：7.31±1.45 vs. 10.12±3.15, T48： 6. 855=2.27 vs. 9.99-±1.79, T72： 5. 455=1.68 vs. 7.91±3.33, P^0.05 or P〈0.01], while there were no differences on CVP and SVRI between the two groups at each time point （all P〉0.05）. The 28-day mortality in treatment group was lower than that in control group （45.6% vs. 80.0%）, but no statistical significant difference was found （P〉0. 05）. Conclusion The resuscitation mixture can obviously increase CI and GEDVI, and decrease EVLWI, but it has no effect on CVP, SVRI and 28-day mortality.