中药加味潜阳丹对感染性休克早期液体复苏时血管外肺水及相关因素的影响

Effect of Modified Qianyang Pellet on Extravascular Lung Water and Its Correlated Factors at the Early Fluid Resuscitation Stage of Septic Shock

目的探讨感染性休克早期液体复苏时加用中药加味潜阳丹对血管外肺水及相关因素的影响。方法 48例感染性休克患者随机分为中药组(26例)和对照组(22例),两组均以液体复苏至患者中心静脉压(central venous pressure,CVP)≥8mmHg作为复苏终点,并施以内科基础治疗,中药组同时加用中药加味潜阳丹。监测液体复苏结束后即刻(T0)、8h(T8)、16h(T16)、24h(T24)的CVP、心排血指数(cardiac index,CI)、血管外肺水指数(extra-vascular lung water index,EVLWI)、体循环阻力指数(systemic vascular resistance index,SVRI)、全心舒张末期容积指数(global end-diastolic volume index,GEDVI)、氧合指数[oxygenation index,动脉血氧分压(PaO2)/吸氧浓度(FiO2)]等指标的变化及28天病死率。结果中药组在治疗T8、T16、T24时CI、GED-VI、PaO2/FiO2较对照组明显增加(P<0.05,P<0.01),EVLWI明显降低(P<0.01);两组相同时间点CVP、SVRI比较,差异均无统计学意义(P>0.05);两组28天病死率比较,中药组明显低于对照组,差异有统计学意义(P<0.05)。结论在液体复苏及常规治疗基础上,加用中药加味潜阳丹可以进一步降低感染性休克早期液体复苏时EVLWI及28天病死率,增加CI、GEDVI、PaO2/FiO2,而对CVP、SVRI影响不明显。

Objective To investigate the effect of modified Qianyang Pellet （MQYP） on extravascular lung water and its correlated factors at the early fluid resuscitation stage of septic shock. Methods Forty-eight patients with septic shock were randomly assigned to the treatment group （26 patients） and the control group （22 patients）. They were treated with basic treatment combined with fluid resuscitation until the central venous pressure （CVP） reached ≥8 mm Hg. Besides,patients in the treatment group received MQYP additionally. The haemodynamic indices,including CVP,cardiac index （CI）,extravascular lung water index （EVLWI）,systemic vascular resistance index （SVRI）,global end-diastolic volume index （GEDVI）,and oxygenation index （PaO2/FiO2） were monitored at 8 （T8）,16 （T16） and 24 h （T24） after ending fluid resuscitation,and the 28-day mortality was observed. Results Compared with the control group,CI,GEDVI and PaO2/FiO2 increased significantly at T8,T16 and T24,while EVLWI and 28-day mortality lowered in the treatment group （P0.05 or P0.01）. But the difference in terms of CVP and SVRI between the two groups at corresponding time points was statistically insignificant （P0.05）. Conclusion On the basis of the fluid resuscitation and basic treatment,MQYP could further improve CI,GEDVI and PaO2/FiO2,decrease EVLWI and 28-day mortality,but showed no effect on CVP or SVRI at the early fluid resuscitation stage of septic shock.