真武汤加减对液体复苏后“痰饮症”患者中心静脉压、氧合指数以及下腔静脉呼吸变异指数的影响

Effect of Zhenwu decoction on central venous pressure,oxygenation index and inferior vena cava respiratory variation index in patients with phlegm syndrome after fluid resuscitation

目的:探讨加减真武汤对液体复苏后“痰饮症”患者中心静脉压、氧合指数以及下腔静脉呼吸变异指数的影响。方法:将104例完成液体复苏后的液体过负荷的感染性休克患者随机分为两组,对照组52例,给予常规西医脱水治疗;研究组52例,在对照组基础上给予真武汤加减治疗。比较两组患者治疗前后的临床疗效、中医证候积分、中心静脉压(CVP)、氧合指数(OI)以及下腔静脉呼吸变异指数(RVI)的变化。结果:研究组总有效率92.31%高于对照组73.07%(P<0.05);治疗后中医症候积分较治疗前均有所下降,且研究组低于对照组,差异有统计学意义(均P<0.05);脱水治疗后,研究组和对照组CVP在1、7、14 d逐渐降低,差异有统计学意义(均P<0.05);两组患者在不同时间段OI不断升高,且研究组高于对照组,差异有统计学意义(均P<0.05);RVI在不同时间段逐渐降低,且研究组低于对照组,差异有统计学意义(均P<0.05)。结论:真武汤加减能有效改善液体复苏后“痰饮症”患者的临床症状,降低中心静脉压,提高氧合指数,降低呼吸变异指数。

Objective:To investigate the effect of modified Zhenwu decoction on central venous pressure,oxygenation index and respiratory variation index of inferior vena cava in patients with phlegm retention syndrome after fluid resuscitation.Methods:104 patients with septic shock after fluid resuscitation were randomly divided into two groups:a control group of 52 cases,receiving conventional Western medicine dehydration treatment,and a study group of 52 cases,receiving modified Zhenwu Tang treatment on the basis of the control group.Clinical efficacy,TCM syndrome integral,central venous pressure(CVP),oxygenation index(OI)and respiratory variability index(RVI)of inferior vena cava were compared between the two groups before and after treatment.Results:The total effective rate in the study group(92.31%)was higher than that in the control group(73.07%)(P<0.05).After the treatment,the scores of TCM symptoms in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05),After dehydration treatment,the CVP of the study group and the control group gradually decreased on day 1,7,and 14,with statistically significant differences(all P<0.05);The OI levels of the two groups of patients continued to increase at different time periods,and the study group was higher than the control group,with statistically significant differences(all P<0.05).RVI decreased gradually at different time points after fluid resuscitation,and the study group was lower than that of the control group,with statistical significance(P<0.05).Conclusion:Zhenwu decoction can effectively improve the clinical symptoms of patients with phlegm retention syndrome after fluid resuscitation,reduce central venous pressure,improve oxygenation index and reduce respiratory variability index.