早期补充维生素C对脓毒症患者预后的影响

Effect of early exogenous vitamin C supplementation on prognosis of sepsis patients

目的探讨早期给予静脉补充维生素C能否改善脓毒症患者的预后。方法选取2017年6月1日-2018年5月31日河南省人民医院重症监护病房(ICU)收治的脓毒症患者234例,通过前瞻性随机对照研究方法,将患者分为维生素C组(122例)及对照组(112例)。对照组采用基础治疗方案,并应用5%葡萄糖注射液100 ml静脉滴注;维生素C组在基础治疗方案上,用3 g维生素C溶解于5%葡萄糖注射液100 ml,静脉滴注,1次/d。比较两组28 d后的病死率、疗效及影响因素。结果维生素C组28 d病死率(27.9%)较对照组(42.9%)降低(P<0.05),72 h△SOFA评分较对照组升高[4.0(1.0~6.0)VS 2.0(1.0~4.0)](P<0.05),血管活性药物应用时间较对照组缩短[25.0(18.0~40.0)VS 43.0(24.0~66.0)](P<0.05),降钙素原清除率较对照组增加[79.0%(66.0%~85.0%)VS 60.0%(50.0%~66.0%)](P<0.05)。两组ICU住院时间差异无统计学意义[4.00(3.00~8.00)d VS 4.00(3.00~7.25)d](P>0.05)。结论早期静脉补充维生素C可以降低脓毒症患者的28 d病死率,降低SOFA评分,缩短血管活性药物应用的时间,提高降钙素原清除率,从而改善脓毒症患者的预后。

Objective To investigate whether early exogenous intravenous vitamin C supplementation could improve the prognosis of sepsis patients.Methods The sepsis patients were selected from general ICU of Henan province people’s hospital from June 1,2017 to May 31,2018.The sepsis patients were randomly divided into vitamin C group(n=122)and control group(n=112)through the design of prospective randomized controlled study.The vitamin C group based on the foundation treatment,and further was given the application of vitamin C(3 g dissolving in 100 ml 5%glucose injection)once a day in ICU treatment.The control group only used the foundation treatment and 100 ml 5%glucose injection.The case fatality rate of 28 days was analyzed by chi-test,t test or nonparametric test was used to evaluate the therapeutic effect of vitamin C on sepsis patients and further Logistic regression analysis was used to explore the influencing factors for fatality rate of 28 days.Results Compared with control group,the patients in vitamin C group have lower 28-day fatality rate(27.9%VS 42.9%,P<0.05);72 h△SOFA score was obviously reduced[4.0(1.0,6.0)VS 2.0(1.0,4.0),P<0.05];vascular active drug application time was shorten[25.0(18.0,40.0)VS 43.0(24.0,66.0),P<0.05];the removal rate of calcitonin was increased[79.0%(66.0%,85.0%)VS 60.0%(50.0%,66.0%),P<0.05].There was no significant difference in ICU hospitalization time between the two groups[4.00(3.00,8.00)vs 4.00(3.00,7.25),P>0.05].Conclusions Early intravenous vitamin C can reduce the fatality rate of 28 days and SOFA score,shorten the time of the vascular active drug application,improve the procalcitonin clearance,and finally improve the prognosis of patients with sepsis.