五参汤联合乌司他丁对感染性休克后肺毛细血管渗漏综合征患者肺氧合功能、促炎-抗炎系统、氧化-抗氧化系统失衡的影响

Effects of Wushen Decoction combined with ulinastatin on pulmonary oxygenation, proinflammatory-anti-inflammatory system and oxidation-antioxidant system imbalance in patients with pulmonary capillary leakage syndrome after septic shock

目的观察五参汤联合乌司他丁对感染性休克后肺毛细血管渗漏综合征(CLS)患者肺氧合功能、促炎-抗炎系统、氧化-抗氧化系统失衡的影响。方法将60例感染性休克后肺CLS患者随机分为观察组和对照组,每组各30例;对照组给予乌司他丁治疗,观察组在对照组的基础上加用五参汤治疗。观察2组治疗期间血流动力学、肺氧合功能、呼吸力学、炎症和氧化应激相关指标的变化,记录2组临床预后和结局情况。结果 2组治疗后6 h、12 h、24 h、48 h血流动力学参数显著改善(P均<0.05),且观察组治疗后24 h、48 h以上指标恢复情况明显优于对照组(P均<0.05);2组治疗后1 d、3 d、5 d的肺氧合指标、血管外肺水指数(EVLWI)和肺血管通透指数(PVPI)、呼吸力学参数、炎症反应和氧化应激指标均显著改善(P均<0.05),观察组以上时间点的此类指标改善情况均明显优于对照组(P均<0.05)。2组治疗后SOFA评分、APACHEⅡ评分、Murray肺损伤评分均显著降低(P均<0.05),观察组治疗后以上评分均明显低于对照组(P均<0.05)。观察组机械通气时间、住院时间、血培养转阴时间、胸部体征恢复正常时间、日均补液量、日均去甲肾上腺素用量、病死率均明显短于或低于对照组(P均<0.05)。结论五参汤联合乌司他丁可稳定感染性休克后CLS患者血流动力学,改善肺毛细血管通透性、肺氧合功能和呼吸力学参数,降低病死率,改善预后,其机制可能与促进机体促炎-抗炎、氧化-抗氧化系统平衡有关。

Objective It is to observe the effects of Wushen Decoction combined with ulinastatin on pulmonary oxygenation, proinflammatory-anti-inflammatory system and oxidation-antioxidant system imbalance in patients with pulmonary capillary leakage syndrome(CLS) after septic shock. Methods Sixty patients with pulmonary CLS after septic shock were randomly divided into observation group and control group, 30 cases in each group. The control group was treated with ulinastatin, and the observation group was treated with Wushen decoction on the basis of the control group. The Changes of hemodynamics, pulmonary oxygenation, respiratory mechanics, inflammation, and oxidative stress were observed during treatment periods. The clinical outcomes and outcomes of the two groups were recorded. Results The indicators of hemodynamics at 6 h, 12 h, 24 h and 48 h after treatment were significantly improved in the two groups, the recovery of the above indexes at 24 h and 48 h in the observation group was significantly better than that of the control group(P<0.05). The indexes of pulmonary oxygenation, extravascular lung water index(EVLWI), and pulmonary vascular permeability index(PVPI), respiratory mechanics parameters inflammation, and oxidative stress at 1 d, 3 d, and 5 d after treatment were significantly improved compared with those before treatment in the two groups, the improvement of such indicators at the time point in the observation group was better than that of the control group(P<0.05). After treatment, the SOFA score, APACH EII score and Murray lung injury score were significantly decreased in the two groups, the above scores of the observation group were lower than those in the control group. The mechanical ventilation time, hospitalization time, blood culture conversion time, chest signs recovery time, daily average fluid volume, daily norepinephrine dosage, and mortality in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Wushen decoction combined with ulinastatin can stabilize hemodynamics in patients with CLS after septic shock, improve pulmonary capillary permeability, improve pulmonary oxygenation and respiratory mechanics parameters, reduce mortality and improve prognosis. The mechanism is related to promoting the body’s pro-inflammatory-anti-inflammatory, oxidative-antioxidant system balance.