加味生脉散治疗脓毒性休克合并急性肾损伤的临床观察

Clinical observation of Jiawei Shengmai San in the treatment of septic shock with acute kidney injury

目的观察加味生脉散对脓毒性休克合并急性肾损伤患者的保护作用。方法选取广州市中西医结合医院重症医学科2018年4月至2020年9月收治的脓毒性休克合并急性肾损伤患者60例,按随机数字表法分为治疗组与对照组各30例。两组均按2012年国际脓毒性休克指南进行治疗,治疗组加用加味生脉散加减,对照组加用等量的温开水,两组疗程均为7 d。分别检测两组治疗前和治疗后第3、7天血清肌酐(Cr)、胱抑素C、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)及尿NGAL、KIM-1水平等,同时记录治疗前后APACHEⅡ评分和SOFA评分。结果两组治疗后血Cr都较治疗前明显降低,差异有统计学意义(P<0.05);治疗组在第7天血胱抑素C显著低于对照组,差异有统计学意义(P<0.05);治疗组从第3天开始血KIM-1及尿KIM-1水平显著低于对照组,差异有统计学意义(P<0.05);治疗组APACHEⅡ及SOFA评分在第7天低于对照组,差异有统计学意义(P<0.05)。结论加味生脉散具有保护脓毒性休克合并急性肾损伤患者肾功能及改善病情的作用。

Objective To observe the protective effect of Jiawei Shengmai San on patients with septic shock with acute kidney injury.Methods Sixty patients with septic shock complicated with acute kidney injury admitted to the ICU of Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine from April 2018 to September 2020 were selected in this study.According to the random number table method,they were divided into a treatment group and a control group with 30 cases in each group.Both groups were treated according to the 2012 International Guidelines for Septic Shock.The treatment group was additionally treated with Jiawei Shengmai San plus or minus,and the control group was additionally treated with the same amount of warm boiled water.The treatment course of both groups was 7 days.The levels of serum creatinine(Cr),cystatin C,neutrophil gelatinaseassociated lipocalin(NGAL),kidney injury molecule-1(KIM-)and urinary NGAL,KIM-1 before treatment and on the 3rd and 7th day after treatment were detected in the two groups respectively.The acute physiology and chronic health score(APACHEⅡscore)and organ failure score(SOFA score)were recorded before and after treatment at the same time.Results The serum Cr levels of the two groups after treatment were significantly lower than that before treatment,and the difference was statistically significant(P<0.05).The levels of serum cystatin C in the treatment group was significantly lower than that in the control group on the 7th day after treatment,and the differences was statistically significant(P<0.05).In addition,the levels of serum KIM-1 and urinary KIM-1 in the treatment group were significantly lower than those in the control group from the 3rd day,and the differences was statistically significant(P<0.05).Meanwhile,the APACHEⅡand SOFA scores of the treatment group were lower than those of the control group on the 7th day after treatment,and the differences were statistically significant(P<0.05).Conclusion Jiawei Shengmai San could protect the renal function and improve the condition of patients with septic shock complicated with acute kidney injury.