参附注射液联合常规西医抗休克治疗对创伤失血性休克病人脑损伤的改善作用

Effect of Shenfu Injection Combined with Conventional Western Medicine on Brain Injury in Patients with Traumatic Hemorrhagic Shock

目的:探讨参附注射液联合常规西医抗休克治疗对创伤失血性休克病人脑损伤的改善作用。方法:选取2018年5月—2023年5月西南医科大学附属中医医院急诊外科收治的创伤失血性休克病人115例作为研究对象,根据不同治疗方法分为A组(50例)与B组(65例)。A组接受常规西医抗休克治疗,B组在A组基础上给予参附注射液。比较两组格拉斯哥昏迷量表(GCS)评分、休克恢复情况(休克指数、乳酸水平、乳酸清除率)、脑组织灌注情况(脑灌注压、脑血流量)、凝血功能[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、国际标准化比值(INR)]、炎性因子水平[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)]及并发症(弥散性血管内凝血、多器官功能障碍综合征、急性呼吸窘迫综合征、肺部感染)发生情况。结果:治疗后24 h,两组GCS评分均升高,且B组GCS评分高于A组,差异均有统计学意义(P<0.05)。治疗后24 h,两组休克指数、乳酸水平均降低,且B组休克指数、乳酸水平低于A组,差异均有统计学意义(P<0.05);治疗后24 h,B组乳酸清除率高于A组,差异有统计学意义(P<0.05)。治疗后24 h,两组脑灌注压、脑血流量均增大,且B组脑灌注压、脑血流量大于A组,差异均有统计学意义(P<0.05)。治疗后24 h,两组TT、PT、APTT、FIB、INR减小,且B组TT、PT、APTT、FIB、INR小于A组,差异均有统计学意义(P<0.05)。治疗后24 h,两组IL-6、IL-10、TNF-α降低,且B组IL-6、IL-10、TNF-α低于A组,差异均有统计学意义(P<0.05)。B组并发症总发生率低于A组,差异有统计学意义(P<0.05)。结论:参附注射液联合常规西医抗休克治疗创伤失血性休克病人的效果较好,可有效改善病人的昏迷与休克状态,增加脑组织灌注,改善凝血功能指标,降低炎性因子水平,减少并发症。

Objective:To explore the effect of Shenfu injection combined with conventional western medicine on brain injury in patients with traumatic hemorrhagic shock.Methods:A total of 115 patients with traumatic hemorrhagic shock were divided into group A(50 cases)and group B(65 cases)according to different treatment methods.Group A received conventional western medicine for anti-shock treatment,group B received Shenfu injection on the basis of group A.The scores of Glasgow Coma Scale(GCS),shock recovery(shock index,lactate level,lactate clearance rate),cerebral perfusion(cerebral perfusion pressure,cerebral blood flow),thrombin time(TT),prothrombin time(PT),activated partial thrombin time(APTT),fibrinogen(FIB),international standard normalized ratio(INR),interleukin-6(IL-6),interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),and complications(disseminated intravascular coagulation,multiple organ dysfunction syndrome,acute respiratory distress syndrome,pulmonary infection)of the two groups were compared.Results:After 24 h of treatment,GCS score of both groups increased,and GCS score of group B was higher than that of group A(P<0.05).After 24 h of treatment,the shock index and lactic acid level of both groups decreased,and the shock index and lactic acid level of group B were lower than those of group A(P<0.05).After treatment,the lactic acid clearance rate of group B was higher than that of group A(P<0.05).After 24 h of treatment,cerebral perfusion pressure and cerebral blood flow increased in both groups,and cerebral perfusion pressure and cerebral blood flow in group B were higher than those in group A(P<0.05).After 24 h of treatment,TT,PT,APTT,FIB,and INR decreased in both groups,and TT,PT,APTT,FIB,and INR in group B were less than those in group A(P<0.05).After 24 h of treatment,IL-6,IL-10 and TNF-α decreased in two groups,and IL-6,IL-10 and TNF-α in group B were lower than those in group A(P<0.05).The incidence of complications in group B was lower than that in group A(P<0.05).Conclusion:Shenfu injection combined with conventional western medicine showed better effect for the treatment of patients with traumatic hemorrhagic shock,which could effectively improve the coma and shock state of patients,increase the perfusion of brain tissue,improve the coagulation function indicators,reduce the level of inflammatory factors and reduce complications.