注射用益气复脉(冻干)联合去甲肾上腺素治疗感染性休克的疗效观察

Clinical observation of Yiqi Fumai(freeze-dried) for Injection combined with noradrenaline in treatment of septic shock

目的探讨注射用益气复脉(冻干)联合重酒石酸去甲肾上腺素注射液治疗感染性休克的临床疗效。方法选取2015年1月—2017年1月在中国人民解放军第二五四医院诊治的感染性休克患者128例,将患者随机分为对照组和治疗组,每组各64例。对照组静脉滴注重酒石酸去甲肾上腺素注射液,0.05~0.5μg/(kg·min),加入到5%葡萄糖注射液中稀释后给药。治疗组在对照组治疗的基础上静脉滴注注射用益气复脉(冻干),2.6~5.2 g注射用益气复脉(冻干)以5%葡萄糖注射液250 m L稀释,1次/d。观察两组患者临床疗效,比较治疗前后两组患者临床指标、乳酸清除率、急性生理和慢性健康评分(APACHEⅡ)和住院病死率。结果治疗后,对照组和治疗组的临床总有效率分别为70.3%、93.8%,两组总有效率比较差异具有统计学意义(P<0.05)。治疗后,对照组尿量、中心静脉血氧饱和度均显著升高,治疗组心率降低,平均动脉压(MAP)、中心静脉压(CVP)、尿量、中心静脉血氧饱和度均显著升高,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组上述临床指标明显优于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者乳酸水平均有所下降,同组治疗前后比较差异有统计学意义(P<0.05);治疗后的第12、24 h,治疗组乳酸水平显著下降,清除率明显上升,两组比较差异具有统计学意义(P<0.05)。治疗后,两组APACHEⅡ评分均显著降低,同组治疗前后比较差异有统计学意义(P<0.05);治疗后,治疗组APACHEⅡ评分明显低于对照组,两组比较差异具有统计学意义(P<0.05)。在治疗后28 d,对照组和治疗组的病死率分别为10.9%、2.8%,两组比较差异具有统计学意义(P<0.05)。结论注射用益气复脉(冻干)联合重酒石酸去甲肾上腺素注射液治疗感染性休克临床疗效显著,可于较短时间内降低患者的血乳酸水平,改善微循环灌注和组织氧代谢情况,具有一定的临床推广价值。

Objective To investigate the clinical curative effect of Yiqi Fumai（freeze-dried） for Injection combined with Noradrenaline Bitartrate Injection in treatment of septic shock. Methods Patients（128 cases） with septic shock in No. 254 Hospital of PLA from January 2015 to January 2017 were randomly divided into control and treatment groups, and each group had 64 cases. Patients in the control group were iv administered with Noradrenaline Bitartrate Injection, 0.05 — 0.5 μg/（kg·min） was diluted in 5% glucose injection. Patients in the treatment group were iv administered with Yiqi Fumai（freeze-dried） for Injection on the basis of the control group, 2.6 — 5.2 g was diluted in 5% glucose injection 250 m L, once daily. After treatment, the clinical efficacies were evaluated, and the clinical indicators, the lactate clearance rate, APACHEⅡ scores, and hospital mortality in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 70.3% and 93.8%, respectively, and there were differences between two groups（P 〈 0.05）. After treatment, the urine volume and central venous oxygen saturation in the control group were significantly increased, and the heart rate, MAP, CVP, urine volume, and central venous oxygen saturation in the treatment group were significantly increased, and there were differences in the same group（P 〈 0.05）. After treatment, the clinical indicators in the treatment group were significantly better than those in the control group, with significant difference between two groups（P 〈 0.05）. After treatment, the lactic acid concentrations in two groups were significantly decreased, and the difference was statistically significant in the same group（P 〈 0.05）. At 12 and 24 h after treatment, the Lactic acid concentrations in treatment group were significantly decreased, but the lactate clearance rates were significantly increased, and the difference was statistically significant between two groups（P 〈 0.05）. After treatment, APACHEⅡ scores in two groups were significantly decreased, and there were differences in the same group（P 〈 0.05）. After treatment, APACHEⅡ scores in the treatment group were lower than those in the control group, and there were differences between two groups（P 〈 0.05）. After 28 d of treatment, the hospital mortality in the control and treatment groups were 10.9% and 2.8%, respectively, and there were differences between two groups（P 〈 0.05）. Conclusion Yiqi Fumai（freeze-dried） for Injection combined with Noradrenaline Bitartrate Injection has significant effect in treatment of septic shock, can reduce the lactic acid concentration within a short time, improve microcirculation perfusion and tissue oxygen metabolism, which has a certain clinical application value.