右旋糖酐40注射液联合高渗氯化钠注射液治疗急性失血性休克患者的临床研究

Clinical trial of dextran 40 injection combined with hypertonic sodium chloride injection in the treatment of acute hemorrhagic shock

目的观察右旋糖酐40注射液联合高渗氯化钠注射液治疗急性失血性休克的临床疗效与安全性。方法将42例急性失血性休克患者随机分为对照组21例和试验组21例。对照组予以4 m L·kg-17.5%高渗氯化钠注射液,静脉滴注5~15 min;试验组在对照组治疗的基础上,予以20 m L·kg-1右旋糖酐40氯化钠注射液,静脉滴注15~30 min。比较2组患者的收缩压(SBP)、血红细胞比容(Hct)、高切值(HBV)、中切值(MBV)、低切值(LBV)、全血黏度(WBV)、休克指数(SI),以及药物不良反应的发生情况。结果治疗后,试验组和对照组的SBP分别为(106.37±10.12)和(92.57±9.11)mm Hg,Hct分别为(56.35±3.02)%和(40.84±4.22)%,HBV分别为(3.21±0.45)和(3.84±0.54)m Pa·s,MBV分别为(3.78±0.54)和(5.02±0.71)m Pa·s,LBV分别为(6.73±0.84)和(7.85±1.12)m Pa·s,WBV分别为(1.23±0.17)和(1.87±0.24)m Pa·s,SI分别为(0.49±0.07)和(0.61±0.08),差异均有统计学意义(均P>0.05)。对照组的药物不良反应主要为轻度胸闷,试验组的药物不良反应主要为瘙痒。试验组和对照组的总药物不良反应发生率分别为9.52%和4.76%,差异无统计学意义(P>0.05)。结论右旋糖酐40注射液联合高渗氯化钠注射液能有效地升高急性失血性休克患者的血压,纠正休克状态,改善血流动力学指标,且不增加药物不良反应的发生率。

Objective To observe the clinical efficacy and safety of the dextran 40 injection combined with hypertonic sodium chloride injection in the treatment of acute hemorrhagic shock. Methods Forty-two patients with acute hemorrhagic shock were randomly divided into control group and treatment group with 21 cases per group. Control group was given 7. 5% hypertonic sodium chloride injection at the speed of 4 m L·kg-1 for 5-15 min,intravenous drip. Treatment group was given dextran 40 injection at the speed of 20 m L · kg-1 for 15-30 min,intravenous drip,on the basis of the control group. The systolic blood pressure（ SBP）, plasma hematocrit（ Hct）, high blood viscosity（ HBV）,middle shear whole blood viscosity（ MBV）,low shear whole blood viscosity（ LBV）,whole blood viscosity（ WBV）,shock index（ SI） and adverse drug reactions were compared between two groups.Results After treatment,the main indexes in treatment and controlgroups were compared： SBP were（ 106. 37 ± 10. 12） and（ 92. 57 ± 9. 11） mm Hg,Hct were（ 56. 35 ± 3. 02） % and（ 40. 84 ± 4. 22） %,HBV were（ 3. 21 ± 0. 45） and（ 3. 84 ± 0. 54） m Pa · s,MBV were（ 3. 78 ± 0. 54） and（ 5. 02 ± 0. 71） m Pa·s,LBV were（ 6. 73 ± 0. 84） and（ 7. 85 ± 1. 12） m Pa ·s,WBV were（ 1. 23 ± 0. 17） and（ 1. 87 ± 0. 24） m Pa·s,SI were（ 0. 49 ± 0. 07） and（ 0. 61 ± 0. 08） with significant difference（ all P〈0. 05）. The adverse drug reactions in control group were based on mild chest tightness,which in control group were itching. The incidences of adverse drug reactions in treatment and control groups were 9. 52% and 4. 76% without significant difference（ P〈0. 05）. Conclusion Dextran 40 injection combined with hypertonic sodium chloride injection has a definitive clinical efficacy in increasing the blood pressure in patients with acute hemorrhagic shock,correcting shock state and improving hemorheology indicators,without increasing the incidence of adverse drug reactions.