化瘀解毒法对脓毒症休克血流动力学障碍的影响

Effect of Removing Blood Stasis and Detoxification Method on Hemodynamic Disorders with Septic Shock

目的:观察化瘀解毒法对脓毒症休克患者血流动力学障碍的影响。方法:前瞻性研究纳入脓毒症休克患者共66例,随机分为化瘀解毒组35例与对照组31例。对照组按照2012年指南进行进行常规治疗;化瘀解毒组在指南治疗的基础上加用血必净注射液治疗。观察记录2组患者C-反应蛋白(CPR)、降钙素原(PCT)、血乳酸(LAC);对Pi CCO监测的患者,记录血流动力学指标、去甲肾上腺素的用量;记录2组患者凝血功能,患者28天生存率。结果:治疗第5天,化瘀解毒组SOFA评分明显小于对照组,化瘀解毒组CRP水平呈下降趋势,对照组呈上升趋势,2组间比较,差异有统计学意义(P<0.05)。治疗5天后,化瘀解毒组活化部分凝血活酶时间(APTT)下降,对照组APTT升高,2组间比较,差异有统计学意义(P<0.05)。化瘀解毒组28天生存率85.7%,高于对照组57.7%,差异有统计学意义(P<0.05)。2组在4 h、12 h、24 h、48 h、72 h和5天时去甲肾上腺素用量方面比较,差异无统计学意义(P>0.05)。治疗第5天,2组PCT、LAC水平、凝血指标血小板计数(BPC)、凝血酶原时间(PT)、纤维蛋白原(FIB)比较,差异均无统计学意义(P>0.05)。因病情需要,15例脓毒症休克患者采用Pi CCO监测,其中化瘀解毒组10例,对照组5例。化瘀解毒组与对照组相比较,2组在治疗前、24 h、48 h外周循环阻力(SVR)、外周循环阻力指数(SVRI)方面比较,差异均无统计学意义(P>0.05)。结论:化瘀解毒法能够提高患者的28天生存率,在改善血流动力学、减少血管活性药物使用方面有一定意义,且不增加出血风险。

Objective：To observe the effect of method of removing blood stasis and detoxification on patients of septic shock with hemodynamic disorders.Methods：66 cases of patients with septic shock were included in a prospective study and they were divided into the group of removing blood stasis and detoxification being 35 cases and the control group being31 cases randomly.The control group received routine therapy according to the guide of 2012,while the group of removing blood stasis and detoxification was additionally treated with Xuebijing injection.Observed and recorded C-reactive protein（CRP）,procalcitonin（PCT）,and lactic acid（LAC）of patients in both groups.For patients monitored by PiCCO,hemodynamic parameters and the amount of norepinephrine were recorded.Recorded coagulation function and 28-day survival rate of patients in two groups.Results：On the 5 th day of treatment,SOFA scores in the the group of removing blood stasis and detoxification were obviously lower than those in the control group.The level of CRP in the group of removing blood stasis and detoxification showed a trend of decreasing,while it showed a trend of increasing in the control group,difference being significant（P 0.05）.After five days of treatment,activated partial thromboplastin time（APTT）in the group of removing blood stasis and detoxification decreased,while the APTT in the control group increased,difference being significant（P 0.05）.28-day survival rate was 85.7% in the the group of removing blood stasis and detoxification,being higher than 57.7% in the control group,difference being significant（P 0.05）.At the 4 th,12 th,24 th,48 th,72 th hour and 5 th day of treatment,the amount of norepinephrine between two groups,difference being insignificant（P 0.05）.On the 5 th day of treatment,there were no significant differences being found in the comparisons of PCT,LAC,blood coagulation index,blood platelet count（BPC）,prothrombin time（PT）,and fibrinogen（FIB）between two groups（P 0.05）.Fifteen patients with septic shock were monitored with PiCCO due to their illness condition,including 10 cases in the group of removing blood stasis and detoxification and 5 cases in the control group.Comparing the group of removing blood stasis and detoxification with the control group,there were no significant differences being found in the comparisons of peripheral circulation resistance（SVR）and peripheral circulation resistance index（SVRI）at the 0 th,24 th,and 48 th hour in the treatment（P 0.05）.Conclusion：The method of removing blood stasis and detoxification can improve the 28-day survival rate of patient,and has a significant effect in improving hemodynamics and reducing vasoactive drug application,without increasing the risk of bleeding.