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参附注射液治疗重症感染性休克的疗效观察及对血乳酸、炎性因子的影响

Effect of Shenfu injection on blood lactate and inflammatory factors in patients with severe infectious shock

摘要:

目的 探讨参附注射液治疗重症感染性休克的疗效及对血乳酸、炎性因子的影响.方法 采用随机数字表法将116例重症感染性休克患者分为对照组及观察组,每组58例,对照组给予西医基础治疗,观察组在对照组治疗基础上加用参附注射液,两组患者均治疗7d.观察两组治疗前后患者生命体征改变,包括心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、血乳酸水平(Lac)、尿量、急性生理与慢性健康评分(APACHEⅡ).观察两组治疗前后炎性因子的变化,包括肿瘤细胞坏死因子(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)的水平变化情况.观察两组患者28 d病死率及平均住院天数.结果 治疗后,对照组HR与治疗前差异无统计学意义[(121.32±11.85)次/min比(123.65±14.05)次/min,t=1.66,P=0.98],观察组与治疗前差异有统计学意义[(96.55±10.65)次/min比(123.60±13.98)次/min,t=11.84,P=0.00];两组MAP、CVP均较治疗前增高,且观察组高于对照组,差异均有统计学意义(均P<0.05);两组尿量较治疗前增多,观察组高于对照组,差异有统计学意义(t=20.40,P=0.00).对照组Lac较治疗前降低,差异有统计学意义(P<0.05);两组APACHEⅡ评分、TNF-α、IL-6、CRP较治疗前降低,且观察组均低于对照组,差异均有统计学意义(均P<0.05);两组28 d病死率差异无统计学意义(13.79%比22.41%,χ2=1.45,P=0.23);观察组平均住院天数[(23.39±5.81)d]短于对照组[(28.76±6.23)d],差异有统计学意义(t=6.52,P=0.00).结论 参附注射液可改善重症感染性休克患者生命体征,降低血内Lac浓度,改善炎性因子水平.

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abstracts:

Objective To investigate the effects of dopamine combined with norepinephrine on blood lactate and inflammatory factors in elderly patients with severe septic shock. Methods 116 patients with severe septic shock were randomly divided into control group and observation group according to the random number table method , 58 cases in each group. The control group was given the basic treatment of western medicine,the observation group was given Shenfu injection on the basis of the treatment of the control group. The patients were treated for 7 days. The heart rate ( HR) ,mean arterial pressure ( MAP) ,central venous pressure ( CVP) ,blood lactate ( Lac) ,urine output, acute physiology and chronic health score ( APACHEⅡ) were observed before and after treatment. The tumor necrosis factor ( TNF- α) , interleukin -6 ( IL -6 ) and C - reactive protein ( CRP ) were measured before and after treatment. The changes of inflammatory cytokines were observed before and after treatment. The 28-day mortality and average length of hospital stay were observed. Results After treatment,the HR of the control group was not improved compared with before treatment[(121. 32 ± 11. 85)beats/min vs. (123. 65 ± 14. 05)beats/min,t=1. 66,P=0. 98]. The HR of the observation group decreased, and there was significant difference compared with before treatment [(96. 55 ± 10. 65) beats/min vs. (123. 60 ± 13. 98) beats/min,t=11. 84,P=0. 00]. The MAP and CVP of the two groups were higher than before treatment,and there were significant differences compared with before treatment ( all P<0. 05). The urine volume of the two groups was higher than before treatment,and that of the observation group was higher than the control group (t=20. 40,P=0. 00). The score of APACHEⅡ,TNF-α,IL-6 and CRP of the two groups were lower than before treatment,which of the observation group were lower than those of the control group ( all P<0. 05). The difference of 28-day mortality rate between the two groups was not statistically significant(13. 79%vs. 22. 41%,χ2 =1. 45,P=0. 23). The average hospital stay of the observation group was shorter than that in the control group [(23. 39 ± 5. 81)d vs. (28. 76 ± 6. 23)d,t=6. 52,P=0. 00]. Conclusion Dopamine combined with norepinephrine can improve the vital signs of patients with severe septic shock,reduce the concentration of lactate in blood,improve the level of inflammatory factors and heart index.

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