大黄制剂联合参麦注射液治疗脓毒血症合并急性肾功能损伤32例

Dahuang Preparation Combined with Shenmai Injection in Treating 32 cases of Pyemia Combined with Acute Renal Function Injury

目的:探讨大黄制剂联合参麦注射液治疗脓毒血症合并急性肾功能损伤的临床疗效及对炎症因子的影响。方法:将64例患者按就诊顺序随机分为观察组、对照组各32例,2组患者积极予以常规治疗,对照组以参麦注射液60~100 m L加入5%葡萄糖注射液250 m L中,静脉滴注,2次/d。观察组在对照组治疗基础上以大黄粉剂15 g冲入50 m L温开水中口服,2次/d;大黄片剂,水煎200 m L,保留灌肠,1次/d。2组均连续治疗3天。比较2组患者临床疗效及治疗前后肾功能和炎症因子水平。结果:观察组治疗3天内死亡2例,病死率为6.89%(2/29);对照组治疗3天内死亡8例,病死率为26.67%(8/30),2组比较差异有统计学意义(P<0.05)。治疗3天后存活患者器官功能衰竭评分(SOFA)和急性生理与慢性健康Ⅱ评分(APACHEⅡ)、血肌酐(SCr)、尿素氮(BUN)及尿N-乙酰氨基葡萄糖糖苷酶(NAG)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)、白细胞介素6(IL-6)、C反应蛋白(CRP)水平治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后2组组间比较差异有统计学意义(P<0.05)。结论:大黄制剂联合参麦注射液治疗脓毒血症合并急性肾功能损伤可显著减轻患者炎症水平、改善肾功能损伤程度、降低死亡率。

Objective:To discuss curative effects of Dahuang preparation and Shenmai injection in the treatment for pyemia joined with acute renal function injury and its influnence on inflammatory factors.Methods:All64 patients were randomized into the observation group and the control group according to the visiting order,32 cases each group,both groups accepted conventional therapy positively,and the control group intravenous dripping of Shenmai injection,60~100 m L,adding to 5%glucose injection,250 m L,twice each day.The observation group took Dahuang preparation in which containing Dahuang powder,15 g,and mixing with warm water,50 m L,twice each day;Dahuang tablets,water decoction,200 m L,retention enema,once each day.Both groups were treated for three consecutive days.To compare clinical effects,the levels of renal function and inflammatory factors before and after treating in both groups.Results:Two case died within three days after treating,mortality of the observation group was 6.89%(2/29);eight cases died within three days after treating,mortality of the control group was 26.67%(8/30),and the diffference had statistical meaning between both groups(P<0.05).The difference could be found in SOFA,APACHEⅡ,the levels of SCr,BUN,NAG,TNF-α,PCT,IL-6 and CRP in the survivors within two groups before and after treating(P<0.05);the difference had statistical meaning between both groups after treating(P<0.05).Conclusion:Dahuang preparation and Shenmai injection in the treatment for pyemia complicated with acute renal function injury could notably lower the levels of inflammatory factor,improve renal function injury and reduce the mortality.