应用PiCCO评估参附注射液对感染性休克患者血流动力学的影响及预后

Effects of the Shenfu injection on septic shock by applying PiCCO evolution

目的:应用Pi CCO评估参附注射液对感染性休克患者血流动力学的影响及其预后。方法:选取2012年1月-2014年1月我院ICU收治的感染性休克病人40例,随机分为治疗组及对照组,每组各20例,两组患者根据2012年感染性休克指南进行集束化治疗,治疗组加用参附注射液100m L,对照组加用生理盐水100m L,连续用药7d。两组患者均应用Pi CCO进行血流动力学参数的监测以及抽血化验血乳酸水平的变化,比较两组患者治疗前及治疗后6h,24h,3d,7d的血乳酸及血流动力学参数的变化,观察两组患者的7d、28d生存率以及ICU住院天数。结果:治疗6h后,治疗组及对照组患者LAC均较治疗前显著性降低(P值分别为0.012及0.009),治疗后7d治疗组患者的LAC显著低于对照组(P=0.027)。治疗6h后,两组患者的GEDI、CI及SVRI均较治疗前显著性升高(P值均<0.05),PVPI及EVLWI未见显著性差异(P值均>0.05)。治疗后3d及7d两组患者的PVPI及EVLWI较治疗前显著性降低(P值均<0.05),且治疗后7d治疗组患者的CI、PVPI及EVLWI显著优于对照组(P值均<0.05)。治疗组患者ICU住院天数显著性少于对照组(P=0.027),两组患者的7d病死率无显著性差异(P=0.375),但是28d病死率,治疗组显著低于对照组(P=0.044)。结论:参附注射液通过改善患者的微循环,以及提高患者的心脏功能、降低血管的通透性和减少血管外肺水等作用,降低感染性休克患者的病死率。

Objective：To analyze the effects of the Shenfu injection on septic shock by applying PiCCO evolution. Methods：From January 2012 to January 2014, 40 cases of septic shock were randomly divided into the treatment group and the control group, 20 cases in each group. According to 2012 guidelines cluster of treatment, two groups were treated by sepsis bundle. The treatment group was given the Shenfu injection 100mL;the control group were treated with saline 100mL, for seven days. Results：In 6h, LAC level in the treatment group and the control group decreased significantly （P=0.012 and 0.009）;in 7d, LAC level in treatment group was significantly lower than that in the control group （P=0.027）. In 6h, the GEDI, CI and SVRI in two groups significantly increased （P〈0.05）;PVPI and EVLWI were no significant difference （P〉0.05）. In 3d and 7d, PVPI and EVLWI in two groups were significantly decreased （P〈0.05）, and in 7d, the CI, PVPI and EVLWI in treatment group were significantly better than those in the control group （P〈0.05）. In the treatment group, the days of staying ICU was significantly less than the control group （P = 0.027）. Within 7d, the difference of the case fatality rate in two groups was not significant （P=0.375）. Within 28d, the case fatality rate in the treatment group was significantly lower than the control group （P=0.044）. Conclusion：The Shenfu injection improved microcirculation and heart function, reduced vascular permeability and the extravascular lung water, reduce the case fatality rate of septic shock.