维生素C联合氢化可的松及维生素B_1在脓毒症早期的临床研究

Study of vitamin C combined with hydrocortisone and vitamin B_1 treat for the early stage of sepsis

目的探讨维生素C联合氢化可的松及维生素B1在脓毒症早期治疗效果。方法将我院重症监护室(ICU)2017年1月至12月收治的脓毒症患者50例作为研究组,2016年1月至12月收治的脓毒症患者48例作为对照组;对照组采用氢化可的松治疗,研究组采用维生素C联合氢化可的松及维生素B1治疗,比较2组患者的院内病死率、急性肾损伤(AKI)发生率;ICU第1天及第3天血清丙二醛(MDA)及血清超氧化物歧化酶(SOD);ICU第1天、第2天及第3天的器官功能障碍程度(SOFA)评分、降钙素原(PCT)水平及2组患者血管活性药物(去甲肾上腺素、肾上腺素)的应用时间。结果研究组实际病死率(8.0%与31.25%)及AKI发生率(10.00%与33.33%)显著低于对照组(P <0.01);研究组ICU第3天的MDA显著低于对照组同期,SOD显著高于对照组同期(P <0.01);研究组ICU第2天、第3天的PCT水平显著低于对照组同期(P <0.01);研究组第2天、第3天的SOFA评分显著低于对照组同期(P <0.01);研究组去甲肾上腺素及肾上腺素使用时间显著低于对照组(P <0.01)。结论维生素C联合氢化可的松及维生素B1可降低AKI发生率,迅速纠正氧化应激反应,预防器官功能障碍,清除炎症反应,减少血管活性药物应用时间,降低病死率。

Objective To explore the early treatment efficacy of vitamin C combined with hydrocortisone and vitamin B 1 in sepsis.Methods Fifty patients with sepsis admitted to the ICU from January to December in 2017 were selected as the study subjects. Forty-eight sepsis patients treated from January to December in 2016 were used as the control group. The control group were treated with hydrocortisone. the study group were used vitamin C combined with hydrocortisone and vitamin B 1 .The rates of in-hospital mortality and acute kidney injury （AKI） between the two groups were compared; serum malondialdehyde （MDA） and serum superoxide dismutase （SOD） at the 1st and 3rd day of ICU were compared; the SOFA scores, procalcitonin （PCT） levels, and time of application of vasoactive drugs （norepinephrine, epinephrine） between the two groups the 1st, 2nd and 3rd day of ICU were compared .Results The actual mortality rate （8.0% vs 31.25%） and the incidence of AKI （10.00% vs 33.33%） of the study group were significantly lower than those of the control group（ P 〈0.01）; the MDA level of the study group was significantly lower than that of the control group, and the SOD was significantly higher than that of the control group at the 3rd day of ICU, P 〈0.01; the PCT level of the 2nd and 3rd day of the ICU of the study group was significantly lower than that of the control group at the same time（ P 〈0.01）; the SOFA scores at the 2ndd and 3rd day of ICU of the study group were significantly lower than the control group at the same time,（ P 〈0.01）; the norepinephrine and epinephrine use time of the study group was significantly lower than that of the control group,（ P 〈0.01）.Conclusion Vitamin C combined with hydrocortisone and vitamin B1 can reduce the incidence of AKI, quickly correct oxidative stress response, prevent organ dysfunction, eliminate inflammatory response, reduce the application time of vasoactive drugs, and reduce mortality.