疏血通注射液对脓毒性休克患者微循环的影响

Effect of Shuxuetong injection on microcirculation of patients with septic shock

目的：分析疏血通注射液对脓毒性休克患者微循环的影响及治疗效果。方法采用前瞻性研究方法。将河北省中医院重症医学科收治的80例脓毒性休克患者按随机数字表法分为疏血通组和常规治疗组，每组40例。两组患者均按照脓毒性休克指南推荐的方法进行积极的液体复苏和抗感染等常规治疗；疏血通组在常规治疗基础上给予疏血通注射液6 mL加5%葡萄糖注射液250 mL静脉滴注（静滴），每日1次，共用7 d。观察两组患者治疗前后的尿量、乳酸（Lac）、尿素氮（BUN）、肌酐（Cr）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、左室射血分数（LVEF）、心排血指数（CI）。记录两组多巴胺、多巴酚丁胺、去甲肾上腺素等血管活性药物的总用量和28 d病死率。结果两组治疗前尿量、Lac、BUN、Cr、AST、ALT、LVEF、CI水平比较差异均无统计学意义（均P＞0.05）；两组治疗后尿量、LVEF、CI均较治疗前增加，Lac、BUN、Cr、AST、ALT均较治疗前明显降低，且以疏血通组变化更显著〔尿量（mL/h）：112.1±39.8比73.3±28.5，LVEF：0.49±0.15比0.44±0.14，CI（mL＆#183;s-1＆#183;m-2）：66.2±5.7比54.2±6.2，Lac（mmol/L）：3.83±1.65比4.72±2.25，BUN（mmol/L）：7.1±2.7比9.3±3.5，Cr（μmol/L）：73.9±16.2比95.7±15.8，AST（U/L）：39.8±9.5比45.8±12.7，ALT（U/L）：34.3±9.7比41.7±11.3，均P＜0.05〕。疏血通组各种血管活性药物的总用量均明显少于常规治疗组〔多巴胺（mg）：993.1±261.7比1340.9±356.4，多巴酚丁胺（mg）：776.2±281.0比1049.2±364.3，去甲肾上腺素（mg）：56.4±34.6比107.6±51.3，均P＜0.05〕；疏血通组28 d病死率明显低于常规治疗组〔40.0%（16/40）比60.0%（24/40），P＜0.05〕。结论疏血通注射液可以改善脓毒性休克患者的微循环灌注，降低患者病死率。

Objective To analyze the effect of Shuxuetong injection on microcirculation in patients with septic shock and its therapeutic effect. Methods A prospective study was conducted. Eighty patients with septic shock treated in Department of Critical Care Medicine of Hebei Provincial Traditional Chinese Medical Hospital were randomly divided into a Shuxuetong group and a conventional therapy group according to random number table, 40 cases in each group. The conventional treatment in the two groups was energetically carried out in accord to the sepsis shock guidelines, such as positive fluid resuscitation, anti-infection, etc. In the Shuxuetong group, additionally Shuxuetong injection 6 mL in 5% glucose injection 250 mL intravenous drip was given once a day for 7 days. The levels of urine output, lactic acid （Lac）, blood urea nitrogen （BUN）, creatinine （Cr）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, left ventricular ejection fraction （LVEF）, and cardiac index （CI） in the two groups were observed before and after treatment; the total dosages of dopamine, dobutamine, noradrenaline, etc. vascoactive agent used for the patients and 28-day mortality in the two groups were also recorded. Results The comparisons of levels of urine output, Lac, BUN, Cr, AST, ALT, LVEF, and CI before treatment between the two groups were of no statistical significant differences （all P〉0.05）. After treatment in the two groups, the urine output, LVEF, and CI were increased compared with those before treatment, whereas the Lac, BUN, Cr, AST, and ALT were significantly decreased, and the changes were more obvious in Shuxuetong group [urine output （mL/h）：112.1±39.8 vs. 73.3±28.5, LVEF：0.49±0.15 vs. 0.44±0.14, CI （mL＆#183;s-1＆#183;m-2）：66.2±5.7 vs. 54.2±6.2, Lac （mmol/L）：3.83±1.65 vs. 4.72±2.25, BUN （mmol/L）：7.1±2.7 vs. 9.3±3.5, Cr （μmol/L）： 73.9±16.2 vs. 95.7±15.8, AST （U/L）： 39.8±9.5 vs. 45.8±12.7, ALT （U/L）：34.3±9.7 vs. 41.7±11.3, all P〈0.05]. The total dosages of all kinds of vascoactive agent of Shuxuetong group were remarkably less than those in the conventional therapy group [dopamine （mg）： 993.1±261.7 vs. 1 340.9±356.4, dobutamine （mg）：776.2±281.0 vs. 1 049.2±364.3, noradrenaline （mg）：56.4±34.6 vs. 107.6±51.3, all P〈0.05]. The 28-day mortality of Shuxuetong group was obviously lower than that of conventional therapy group [40.0%（16/40） vs. 60.0%（24/40）, P〈0.05]. Conclusion Shuxuetong injection can improve the microcirculation perfusion in patients with septic shock and reduce their mortality.