中西医结合治疗严重骨创伤后脓毒症临床观察

Clinical Observation of Integrated Chinese and Western Medicine Therapy for Sepsis After Severe Bone Trauma

目的:观察西医疗法联合清源生化汤对严重骨创伤后脓毒症患者循环指标及病情严重程度的影响。方法:将48例严重骨创伤后脓毒症患者随机分为对照组22例及治疗组26例。2组均参照指南进行西医常规治疗,治疗组在常规西医综合治疗的基础上加用清源生化汤口服或鼻饲。观察2组不同时期平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、动脉血乳酸(Lac)、中心静脉血氧饱和度(ScvO_2)、中心静脉-动脉血二氧化碳分压差(Pcv-aCO_2)、急性生理学与慢性健康状况评分系统Ⅱ评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分)、氧合指数(PaO_2/FiO_2)等指标的变化情况。结果:与同时段对照组比较,治疗7天后治疗组的MAP、ScvO_2、Pcv-aCO_2及PaO_2/FiO_2均明显升高,HR、Lac、APACHEⅡ评分及SOFA评分均明显下降,差异均有统计学意义(P<0.05)。结论:西医疗法联合清源生化汤可有效改善严重骨创伤后脓毒症患者的血流动力学异常、改善微循环、提高组织对氧的有效利用、保护多脏器功能、减轻疾病的严重程度。

Objective： To observe the effect of western medicine therapy combined with Qingyuan Shenghua tang on hemodynamics indexes and disease severity of patients with sepsis after severe bone trauma. Methods：Divided 48 cases of patients with sepsis after severe bone trauma randomly into the control group with 22 cases and the treatment group with 26 cases. Both groups received routine treatment of western medicine referring to guidelines, while the observation group additionally received Qingyuan Shenghua tang by oral administration or nasal feeding. Observed changes of mean arterial pressure（MAP）, central venous pressure（CVP）, heart rate（HR）, arterial blood lactic acid（Lac）, central venous oxygen saturation（ScvO2）, central venous-to-arterial carbon dioxide difference（Pcv-aCO2）, scores of acute physiology and chronic health evaluation scoring system Ⅱ（APACHEⅡ scores）,sequential organ failure assessment（SOFA score）,and oxigenation index（PaO2/FiO2） in different periods in both groups. Results：Compared with the control group in the same period,MAP,ScvO2,Pcv-aCO2 and PaO2/FiO2 in the treatment group 7 days after treatment were obviously increased,scores of HR,Lac,APACHE Ⅱ and SOFA were obviously decreased, differences being significant（P〈0.05）. Conclusion：Western medicine therapy combined with Qingyuan Shenghua tang can effectively improve abnormal hemodynamics and microcirculation,increase effective utilization of tissues on oxygen,protect multiple organ function and relieve disease severity of patients with sepsis after severe bone trauma.