大剂量维生素C联合维生素B1辅助治疗脓毒症休克患者的效果

High-dose vitamin C combined with vitamin B1 for patients with septic shock

目的探讨大剂量维生素C联合维生素B1辅助治疗脓毒症休克患者的效果。方法选择2022年1月至8月期间于广州市番禺区何贤纪念医院ICU诊治的90例脓毒症休克患者进行随机对照试验,按照随机数字表法分为对照组(生理盐水)45例,试验组(维生素C+维生素B1)45例。其中对照组男25例,女20例,年龄43~97(74.0±16.64)岁,按照最新的脓毒症和脓毒症休克指南进行液体复苏、抗感染治疗、原发病治疗等;试验组男33例,女12例,年龄35~94(68.0±13.44)岁,在集束化治疗的基础上加予大剂量维生素C及维生素B1。对比两组入住ICU时(T0)及治疗72 h后(T1)的左室射血分数(LVEF)、心排血量(CO)、三尖瓣收缩期位移(TAPSE)等超声结果及T淋巴细胞计数(CD3+、CD4+T、CD8+T)、CD4+/CD8+比例、TNF-α等数据及两组患者ICU住院期间的预后结局。统计学方法采用χ^(2)检验、秩和检验、t检验。结果试验组T1的TNF-α低于对照组[12.96(10.72,19.6)比17.95(11.015,34.75)],差异有统计学意义(Z=-1.96,P<0.05);试验组的CD3+、CD4+、CD8+均高于对照组,差异均有统计学意义(Z=-3.58、-3.15、-3.43,均P<0.05);对照组T1的CD8+较T0下降(Z=-2.26,P<0.05)。试验组T1的CD3+、CD4+、CD8+高于T0,差异均有统计学意义(Z=-3.77、-3.89、-2.91,均P<0.05)。试验组好转率高于对照组[71.11%(32/45)比51.11%(23/45)],两组的预后比较,差异有统计学意义(χ^(2)=8.407,P<0.05)。结论大剂量维生素C联合维生素B1可提升脓毒症休克患者的T淋巴细胞亚群数量,提高患者免疫功能,一定程度上减少TNF-α的产生,改善患者预后。

Objective To explore the effect of high-dose vitamin C combined with vitamin B1 for patients with septic shock.Methods Ninety patients with septic shock who were diagnosed and treated in ICU,Hexian Memorial Hospital of Panyu District from January 2022 to August 2022 were selected for the random control trial.They were divided into a control group(normal saline)and an experimental group(vitamin C+vitamin B1)by the random number table method,with 45 cases in each group.There were 25 males and 20 females in the control group;they were 43-97(74.0±16.64)years old.There were 33 males and 12 females in the experimental group;they were 35-94(68.0±13.44)years old.The control group were treated with fluid resuscitation,anti-infective therapy,and primary disease treatment according to the latest guidelines for sepsis and septic shock;in addition,the experimental group were treated with high-dose vitamin C and vitamin B1.The left ventricular ejection fractions(LVEF),cardiac outputs(CO),tricuspid systolic displacements(TAPSE),and other ultrasonic results,CD3+T lymphocyte counts,CD4+T lymphocyte counts,CD8+T lymphocyte counts,CD4+/CD8+ratios,and tumor necrosis factorα(TNF-α)levels at admission to ICU(T0)and 72 hours after the treatment(T1)and the prognostic outcomes during ICU stay were compared between the two groups.χ^(2),rank sum,and t tests were applied.Results The TNF-αlevel at T1 in the experimental group were lower than that in the control group[12.96(10.72,19.6)vs.17.95(11.015,34.75)],with a statistical difference(Z=-1.96,P<0.05).The CD3+,CD4+,and CD8+in the experimental group were higher than those in the control group,with statistical differences(Z=-3.58,-3.15,and-3.43;all P<0.05).The CD8+at T1 was lower than that at T0 in the control group(Z=-2.26,P<0.05).The CD3+,CD4+,and CD8+at T1 were higher than those at T0 in the experimental group,with statistical differences(Z=-3.77,-3.89,and-2.91;all P<0.05).The improved rate in the experimental group was higher than that in the control group[71.11%(32/45)vs.51.11%(23/45)],with a statistical difference(χ^(2)=8.407,P<0.05).Conclusion High-dose vitamin C combined with vitamin B1 for patients with septic shock can improve their numbers of T lymphocyte subsets,immune function,and prognosis,and reduce the production of TNF–αto some extent.