氢化可的松联合参附注射液治疗脓毒症休克的疗效

The therapeutic effect of hydrocortisone combined with Shenfu injection on septic shock

目的观察氢化可的松联合参附注射液治疗脓毒症休克的临床疗效。方法选取156例脓毒症休克并发毛细血管渗漏综合征(capillary leak syndrome,CLS)的患者为研究对象,随机分为对照组、观察组A、观察组B。对照组给予常规治疗,观察组A给予常规治疗+氢化可的松,观察组B给予常规治疗+氢化可的松+参附注射液。在治疗前、治疗后24、72、96 h应用ELISA法测定血清TNF-α、HMGB-1、ESM-1、VEGF的含量;对比血流动力学参数(EVLWI、MAP、CVP)、氧合指数(OI)、28 d预后。结果与对照组比较,观察组A和观察组B治疗72、96 h血清TNF-α、HMGB-1、ESM-1、VEGF水平明显降低,观察组B低于观察组A(P <0.05)。与对照组比较,观察组A和观察组B治疗24、72、96 h的血流动力学参数、OI明显改善,且观察组B改善情况好于观察组A(P <0.05)。与对照组比较,观察组B患者28 d病死率降低(P <0.05),而观察组A患者28 d病死率未见降低。结论氢化可的松联合参附注射液可改善脓毒症休克患者的预后,其机制可能与减轻毛细血管渗漏有关。

Objective To explore the therapeutic effect of hydrocortisone combined with shenfu injection on septic shock. Methods Total of 156 septic shock patients with capillary leakage syndrome were divided into three groups:observation group A,observation group B and control group.The control group received basic treatment,while the observation group A received hydrocortisone and the observation B group received Shenfu injection combined with hydrocortisone besides basic treatment. The serum levels of TNF-α,HMGB-1,ESM-1 and VEGF were determined by ELISA before and after 24,72 and 96 h of treatment. The hemodynamic parameters of three groups of patients(EVLWI,MAP,CVP)and oxygenation index(OI),and 28 d mortality were compared.Results Compared with the control group,the levels of serum TNF-α,HMGB-1,ESM-1 and VEGF in observation group A and observation group B significantly decreased at 72 and 96 h after treatment,while the levels of those in observation group B were significantly lower than those in observation group A,(P < 0.05). Compared with the control group,hemodynamic parameters and OI of observation group A and observation group B significantly improved after 24,72 and 96 h of treatment,and the improvement of observation group B was better than that of observation group A(P < 0.05). Compared with the control group,the 28 d mortality of patients in the observation group B decreased(P < 0.05),while the 28 d mortality of patients in the observation group A did not decrease.Conclusions Hydrocortisone combined with Shenfu injection could improve the clinical prognosis of patients with septic shock. The mechanism may be related to the reduction of capillary leakage.