参附联合维生素C对脓毒性休克患者血管内皮损伤的保护作用研究

Protective effects of Shenfu injection and vitamin C on vascular endothelial injury in patients with septic shock

目的:探究脓毒性休克患者联合应用参附和维生素C后血管内皮损伤指标的变化。方法:选择2020年8月—2021年7月期间符合纳入及排除标准的40例脓毒性休克患者,根据不同的治疗方案,随机分入常规治疗组、联合治疗组。两组患者均接受脓毒症标准化治疗,在此基础上,联合治疗组在脓毒症标准治疗外联合参附和维生素C治疗。对比两组患者治疗前及治疗后(第1、3、5天)的APACHE-Ⅱ评分、SOFA评分、血浆炎症因子及血管内皮损伤指标(Angiopoietin-2、Syndecan-1)水平。同时,统计两组患者的住院天数、病死率、总费用等数据以评估疗效。结果:两组患者的APACHE-Ⅱ评分和SOFA评分在治疗后第1天、第3天、第5天均下降(P<0.05);组间比较发现,联合治疗组的APACHE-Ⅱ和SOFA评分显著低于常规治疗组,联合治疗组的平均住院天数和血管活性药物使用时间显著低于常规治疗组(P<0.05)。联合治疗组的血清CRP、PCT、IL-6、Angiopoietin-2、Syndecan-1水平在治疗后第1天、第3天、第5天显著低于常规治疗组(P<0.05)。结论:在脓毒性休克患者中,参附和维生素C联合常规治疗方案能够显著减轻血管内皮损伤和炎症反应,从而获得更佳的治疗效果,这可能是一种有前景的治疗方案。

Objective: To investigate the effects of Shenfu injection(SFI) and vitamin C on vascular endothelial injury in patients with septic shock. Methods: A total of 40 patients with septic shock who met the inclusion and exclusion criteria were enrolled from August 2020 to July 2021. They were randomly divided into conventional treatment group and combined treatment group according to various treatment plans. The patients in the conventional treatment group received standard treatment for sepsis shock, while patients in the combined treatment group received standard treatment combined with SFI and vitamin C. The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores, sepsis-related organ failure assessment(SOFA) scores and the levels of inflammatory factors, angiopoietin-2(Ang-2), and syndecan-1 in serum were compared before and after treatment(days 1, 3, and 5) between the two groups. Meanwhile, other data such as hospital stay and mortality of the two groups were collected to evaluate the curative effect. Results: APACHE Ⅱ scores and SOFA scores of patients in both groups decreased at 1, 3 and 5 days after treatment(P<0.05).Compared with the conventional treatment group, APACHE Ⅱ and SOFA scores of the combined treatment group improved more(P<0.05). The average hospital stay and the duration of using vasoactive drugs in the combined treatment group were significantly lower than those in the conventional treatment group(P<0.05). Compared with the conventional treatment group, the serum levels of CRP, PCT, IL-6 and Ang-2 in the combined group decreased significantly at 1, 3 and 5 days after treatment, while syndecan-1 increased at 1, 3 and 5 days after treatment, with statistical significance(P <0.05).Conclusion: SFI and vitamin C combined with conventional treatment can reduce vascular endothelial injury and inflammatory in patients with septic shock, and achieve a better therapeutic effect, which could be a promising treatment method.