参附注射液对ARDS患者血管外肺水及氧合影响的研究

Effects of Shenfu Injection on Extravascular Lung Water and Oxygenation in Patients with ARDS

目的观察参附注射液对急性呼吸窘迫综合征(ARDS)患者血管外肺水(EVLW)及氧合的影响。方法选择2005年1月～2007年12月间上海长征医院ICU收治的42例符合ARDS诊断标准的患者,随机分为研究组(A组21例)与对照组(B组21例),A组患者予以参附注射液100ml加入5%葡萄糖注射液150ml静滴,B组患者予以5%葡萄糖注射液250ml静滴;比较两组患者治疗前、治疗后30min、治疗后3d、治疗后7d心排指数(CI)、EVLW和肺血管通透性指数(PVPI)的变化,氧合指数(PaO2/FiO2)变化及机械通气时间、住院天数及死亡率。结果治疗前两组患者均出现CI下降,EVLW升高,PVPI降低,PaO2/FiO2下降;治疗后30min及注射后3d,A组患者即出现CI上升,EVLW下降,PVPI升高,PaO2/FiO2增加;B组患者无显著性变化。治疗后7dA组患者出现CI明显上升,EVLW显著下降,PVPI明显升高,PaO2/FiO2显著增加;B组也出现CI上升,EVLW下降,PVPI升高,PaO2/FiO2增加,但不如A组患者明显。A组患者机械通气时间、住院天数和死亡率均比B组患者显著性降低。结论参附注射液可改善ARDS患者心脏功能,降低患者EVLW,增加肺血管上皮屏障功能,改善氧合,减少机械通气和住院时间,降低死亡率。

Objective：To evaluate the clinical efficacy of Shenfu Injection on extra vascular lung water（EVLW） and oxygenation in patients with acute respiratory distress syndrome（ARDS）. Methods： 42 patients suffered from ARDS were picked and divided into Shenfu Injection group （group A） and control group （group B）, patients from group A received Shenfu Injection 100ml and 5% glucose 150ml intravenous and those from group B received glucose 250ml intravenous. Then the changes of cardiac index（CI）, EVLW, pulmonary vascular permeability index（PVPI） were observed by pulse indicator continuous cardiac output（PiCCO） and PaO2/FiO2 were measured by blood gas analysis before interfering, 30min later, 3d later and 7d later respectively. Time of intubation, mean days in hospital, and the mortality were compared between the patients of two groups. Results： There was statistically decreasing in CI, statistically increasing in EVLW and tatistically decreasing in PaO2/FiO2 before interference with patients in both groups. While there were statistically increasing in CI, statistically decreasing in EVLW, and statistically increasing in PaO2/FiO2 in patients of group A, there were no statistical changes in patients of group B both 30min later and 3d later. 7d later, there were statistically increasing in CI, statistically decreasing in EVLW, and statistically increasing in PaO2/FiO2 in patients of both groups. Conclusion： Shenfu Injection have the effects of improving cardiac function, decreasing EVLW, improving pulmonary endothelium function, improved oxygenation, lowed the days of inhospital and mortality in patients with ARDS.