早期活血化瘀治疗脓毒性休克的临床研究

The effect of early therapy of promoting blood circulation and removing blood stasis in patients with septic shock

目的:观察早期活血化瘀治疗对脓毒性休克患者的影响。方法:采用前瞻性随机对照研究,选取2010-07-2013-06在江苏省人民医院和泰州市中医院ICU住院的233例脓毒性休克患者为研究对象。随机分为常规治疗组和活血化瘀组,两组均采用脓毒性休克国际指南的集束化治疗方案进行治疗;活血化瘀组则在液体复苏的同时加用活血化瘀药物进行治疗。观察两组患者APACHEⅡ评分、早期复苏目标(EGDT)达标率、治疗前及治疗6h、24h血小板和D-二聚体值变化、乳酸值及乳酸清除率变化、多脏器功能障碍综合征(MODS)评分(Marshall标准)、机械通气时间、ICU住院时间、28d病死率。结果:活血化瘀组血小板在一定程度下降后,逐渐趋于稳定,常规治疗组血小板则明显下降,经统计学分析两组差异有统计学意义(P<0.01)。活血化瘀组D-二聚体在治疗24h后出现明显下降,与治疗6h及常规治疗组比较差异有统计学意义(P<0.01);两组治疗6h及24h乳酸值均出现明显下降,与治疗前比较差异有统计学意义(P<0.01)。但活血化瘀组降低更加明显且具有统计学意义(P<0.05、P<0.01)。活血化瘀组6h及24h乳酸清除率均高于常规治疗组,差异有统计学意义(P<0.05)。两组EGDT达标率比较差异无统计学意义(P>0.05);MODS评分比较差异有统计学意义(P<0.01);两组患者APACHEⅡ评分、机械通气时间、ICU住院时间、28d病死率差异有统计学意义(P<0.05)。结论:脓毒性休克患者进行早期活血化瘀治疗,可以减少病理性血小板及凝血因子消耗,改善组织灌注,缩短机械通气时间、ICU住院时间,降低疾病严重程度及28d病死率。

Objective：To observe the effect of early therapy of promoting blood circulation and removing blood stasis in patients with septic shock.Method：A randomized and prospective study was deployed.Two hundred and thirty three critical patients admitted in traditional Chinese medical hospital and Jiang Su Province People＇s hospital from July,2010 to June,2013,suffering from severe septic shock were randomly divided into conventional treatment group（n=112）and therapeutically group（n=121）increasing by treatment for activating blood circulation in the early treatment.The standard-reaching rate of early recovery goals（EGDT）,changes of platelet and D two dimer value 6h,24 hbefore and after treatment,changes of lactic acid value,lactic acid clearance rate 6hand 24 hafter treatment,multiple organ dysfunction syndrome（MODS）score（Marshall standard）,mechanical ventilation,the length of ICU stay,28-day survival rate were observed and recorded in patients of the two groups.Result：Platelet decreased in a certain degree and gradually stabilized in patients of promoting blood circulation and removing blood stasis group.While in routine treatment group,the platelet was obviously decreased.After the statistical analysis,two groups have significant difference（P〈0.01）.D-two dimer decreased significantly after 24 hin the treatment group,compared with the value 6hafter treatment and routine treatment groups with highly difference（P〈0.01）.The values of lactic acid 6hand 24 hafter treatment decreased significantly compared with the values before treatment（P〈0.01）.Lactate clearance rate 6hand 24 hafter treatment was higher in promoting blood circulation and removing blood stasis group than that in the conventional treatment group with statistical significance（P〈0.05）.The standard-reaching rate of early recovery goals（EGDT）in the two groups had no significant difference（P〈0.05）.MODS score between the two groups had significant difference（P〈0.01）.APACHE Ⅱscore,duration of mechanical ventilation,ICU stay,28 day case fatality rate were significantly different between the two groups of patients（P〈0.05）.Conclusion：Septic shock patients treated with early therapy of promoting blood circulation and removing of blood stasis can reduce the pathologic platelet and coagulation factor consumption,improve tissue perfusion,shorten the mechanical ventilation time,ICU stay,and decrease the severity of diseases and28 day mortality.