参附注射液联合依达拉奉治疗严重胸部创伤致急性肺损伤疗效观察

Curative effect of Shenfu injection combined with edaravone on acute lung injury caused by severe chest trauma

目的观察参附注射液联合依达拉奉治疗严重胸部创伤致急性肺损伤的疗效及对血管内皮细胞功能、机体氧化-抗氧化系统的影响。方法将86例严重胸部创伤致急性肺损伤的患者随机分为观察组43例和对照组43例,对照组给予常规西医综合治疗及依达拉奉注射液静滴,观察组在对照组基础上给予参附注射液静滴,2组均治疗1周。统计2组机械通气时间和ICU住院时间,观察2组治疗前后肺损伤评分(LIS)、器官功能障碍评分(SOFA)、急性生理及慢性健康评分Ⅱ(APACHEⅡ)、氧分压[p(O_2)]、氧合指数[p(O_2)/FiO_2]、二氧化碳分压[p(CO_2)]、气道峰压(PIP)、气道阻力(Raw)、肺顺应性(CL)及血清一氧化氮、内皮素(ET-1)、血管内皮生长因子(VEGF)、超氧化物歧化酶(SOD)、丙二醛(MDA)、总抗氧化能力(T-AOC)、谷胱甘肽过氧化物酶(GSH-Px)水平变化情况。结果观察组机械通气时间和ICU住院时间均明显短于对照组(P均<0. 05)。2组治疗后LIS评分、SOFA评分、APACHEⅡ评分、p(CO_2)、PIP、Raw及血清ET-1、NO、VEGF、v WF、MDA水平均显著降低(P均<0. 05),p(O_2)、p(O_2)/Fi O_2、CL及血清SOD、GSH-Px、T-AOC水平均显著升高(P均<0. 05),且观察组各指标改善情况均显著优于对照组(P均<0. 05)。结论参附注射液联合依达拉奉治疗严重胸部创伤致急性肺损伤能够改善患者血气指标和呼吸功能,可能与减轻氧化应激,保护肺血管内皮细胞功能有关。

Objective It is to observe the curative effect of Shenfu injection combined with edaravone on acute lung injury caused by severe chest trauma and its effect on vascular endothelial cell function and body oxidation-antioxidant system. Methods Eighty-six patients with acute lung injury caused by severe chest trauma were randomly divided into observation group （43 cases） and control group （43 cases）. The control group was treated with conventional western medicine comprehensive treatment and edaravone injection by intravenous infusion. The observation group was treated with Shenfu injection based on the control group. Both groups were treated for 1 week. The mechanical ventilation time and ICU hospitalization time were analyzed. The changes of lung injury score （LIS）, organ dysfunction score （SOFA）, acute physiology and chronic health score II （APACHE II）, and oxygen partial pressure p （O 2）, oxygenation index [（ p （O 2）/FiO 2）], partial pressure of carbon dioxide [ p （CO 2）], peak airway pressure （PIP）, airway resistance （Raw）, lung compliance （CL）, and the levels of serum nitric oxide, endothelin （ET-1）, vascular endothelial growth factor （VEGF）, superoxide dismutase （SOD）, malondialdehyde （MDA）, total antioxidant capacity （T-AOC）, glutathione peroxidase （GSH-Px were observed before and after treatment. Results The mechanical ventilation time and ICU stay time in the observation group were significantly shorter than those in the control group （ P 〈0.05）. After treatment, the LIS score, SOFA score, APACHE Ⅱ score, p （CO 2）, PIP, Raw and levels of serum ET-1, NO, VEGF, vWF and MDA were significantly decreased （ P 〈0.05）, p （O 2）, p （O 2）/FiO 2, CL Serum SOD, GSH-Px and T-AOC were significantly increased （ P 〈0.05）, and the improvement of each index in the observation group was significantly better than that of the control group （ P 〈0.05）. Conclusion Shenfu injection combined with edaravone can improve blood gas index and respiratory function in the treatment of severe lung injury caused by severe chest injury, which may be related to the reduction of oxidative stress and the protection of pulmonary vascular endothelial cells.