参麦注射液联合血液灌流对脓毒性休克患者血流动力学及组织灌注的影响

Effect of Shenmai Injection with Hemoperfusion on Hemodynamics and Tissue Perfusion in Septic Shock

目的探讨参麦注射液联合血液灌流对脓毒性休克患者血流动力学及组织灌注的影响。方法选取2015年1月—2016年8月绍兴市人民医院重症医学科收治的脓毒性休克患者60例,采用随机数字表法分为A、B、C 3组,每组20例。A组患者采用脓毒症常规治疗法治疗,B组患者在A组治疗的基础上加用参麦注射液治疗,C组患者在B组治疗的基础上采用血液灌流治疗。比较3组患者治疗前及治疗7 d后的血流动力学指标[包括心脏指数(CI)、外周血管阻力指数(SVRI)、血管外肺水指数(EVLWI)]、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及实验室检测指标[包括血乳酸(Lac)、前降钙素(PCT)、C反应蛋白(CRP)、脑钠肽(BNP)]。结果治疗前3组患者CI、SVRI、EVLWI、APACHEⅡ评分比较,差异无统计学意义(P>0.05)。治疗后B、C组患者CI、SVRI高于A组,EVLWI、APACHEⅡ评分低于A组;C组患者CI、SVRI高于B组,EVLWI、APACHEⅡ评分低于B组(P<0.05)。治疗前3组患者Lac、PCT、CRP、BNP比较,差异无统计学意义(P>0.05);治疗后B、C组患者Lac、PCT、CRP、BNP低于A组,C组患者Lac、PCT、CRP、BNP低于B组(P<0.05)。治疗期间3组患者均无与药物或血液灌流治疗相关不良反应发生。结论在脓毒性休克常规治疗基础上联合应用参麦注射液和血液灌流,能有效提高脓毒性休克患者心肌收缩能力、稳定血流动力学、增加组织灌注、改善脓毒性休克患者病情。

Objective To investigate the effect of shenmai injection with hemoperfusion on hemodynamics and tissue perfusion in septic shock. Methods We enrolled 60 patients with septic shock treated in the ICU,Shaoxing People＇ s Hospital from January 2015 to August 2016 and randomly divided them into 3 groups with 20 cases in each： group A,group B and group C. All the groups received the conventional therapy. In addition, group B received shenmai injection, and group C received shenmai injection with hemoperfusion. Values of hemodynamic parameters [cardiac index（ CI）, systemic vascular resistance index（ SVRI）,extravascular lung water index（ EVLWI） ],Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHEⅡ） score,values of laboratory parameters [blood lactate（ Lac）,procalcitonin（ PCT）,C-reactive protein（ CRP）,brain natriuretic peptide（ BNP） ]were measured before treatment and after seven days of treatment. Results Before treatment,the values of CI,SVRI,EVLWI and APACHE Ⅱ score did not differ significantly between the groups（ P 0. 05）,while after treatment,compared with groups B and C,group A had lower values of CI and SVRI,but higher value of EVLWI and APACHEⅡ score（ P 0. 05）; group C had higher values of CI and SVRI,but lower value of EVLWI and APACHE Ⅱ score compared with group B（ P 0. 05）. Before treatment,all the groups showed similar values of Lac,PCT,CRP and BNP（ P 0. 05）,but after treatment,the values of Lac,PCT,CRP and BNP in group A were found to be the highest（ P 0. 05）; and those in group C were the lowest（ P 0. 05）. No adverse reactions associated with the pharmacologic therapy or hemoperfusion occurred in all groups during treatment. Conclusion The conventional therapy combined with shenmai injection and hemoperfusion can effectively improving the outcome of septic shock by raising myocardial contractility,stabilizing hemodynamics,and increasing tissue perfusion.