参附注射液对脓毒症休克患者组织灌注和全身氧代谢的影响Effects of Shenfu Injection on Tissue perfusion and Systemic Oxygen Metabolism in patients with Septic Shock
周蕾,张蔚,陈晓卫,鹿宁,姜艳,解建
摘要(Abstract):
目的观察参附注射液对脓毒症休克患者组织灌注指标、全身氧代谢指标、平均ICU住院时间及28d病死率的影响。方法 75例脓毒症休克患者随机分为两组,根据《2008国际严重脓毒症和脓毒症休克治疗指南》6 h EGDT方案+24 h集束化治疗,参附组按EGDT方案第1次液体复苏后应用参附注射液100 mL加入5%葡萄糖注射液250 mL静滴,对照组在同一时间予以5%葡萄糖注射液或0.9%氯化钠注射液250 mL静滴。比较参附组和对照组用药后24 h组织灌注指标、全身氧代谢及两组ICU平均住院时间和28 d预后的差异。结果参附组24 h ScvO2、尿量高于对照组,血Lac低于对照组(P<0.05);参附组DO2高于对照组(P<0.05)。两组O2ER%、VO2及治疗24 h APACHEⅡ评分、ICU住院时间及28 d病死率相近(P>0.05)。结论参附注射液可改善脓毒症休克患者早期24 h组织灌注水平和氧输送水平,对平均ICU住院时间及28 d病死率无影响。
关键词(KeyWords): 参附注射液;脓毒症休克;组织灌注;全身氧代谢;脉搏指数;连续心排血量(PiCCO)
基金项目(Foundation): 山东省烟台市科技局科研课题(2012103)
作者(Author): 周蕾,张蔚,陈晓卫,鹿宁,姜艳,解建
参考文献(References):
- [1]何征宇,皋源,王祥瑞,等.早期目标导向治疗在感染性休克中应用的临床探讨[J].中国危重病急救医学,2007,19(1):14-16.
- [2]Brealey D,Karyampudi S,Jacques TS,et al.Mitochondrial dysfunction in a long-term rodent model of sepsis and organ failure[J].Am J Physiol Regul Integr Comp Physiol,2004,286(3):491-497.
- [3]刘大为.实用重症医学[M].北京:人民卫生出版社,2010:267-271.
- [4]Conti-Patara A,de Araújo Caldeira J,de Mattos-Junior E,et al.Changes in tissue perfusion parameters in dogs with severe sepsis/septic shock in response to goal-directed hemodynamic optimization at admission to ICU and the relation to outcome[J].J Vet Emerg Crit Care(San Antonio),2012,22(4):409-418.
- [5]Jones AE,Shapiro NI,Trzeciak S,et al.Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy:a randomized clinical trial[J].JAMA,2010,24(8):739746.
- [6]Puskarich MA,Trzeciak S,Shapiro NI,et al.Prognostic value and agreement of achieving lactate clearance or central venous oxygen saturation goals during early sepsis resuscitation[J].Acad Emerg Med,2012,19(3):252-258.
- [7]徐军,楼洪刚,楼宜嘉,等.参附注射液药理作用的研究进展[J].上海中医药杂志,2008,42(10):87.
- [8]中华医学会急诊医学分会危重病专家委员会中国中西医结合学会急救医学专业委员会.脓毒症的定义、诊断标准、中医证候诊断要点及说明(草案)[J].中华急诊医学杂志,2007,16(8):797-798.5.
- [9]余洋,康强,王秀英,等.注射用参附药效学实验研究[J].中华中医药学刊,2010(11):2424-2426.
- [10]Hernandez G,Bruhn A,Castro R,et al.The holistic view on perfusion monitoring in septic shock[J].Curr Opin Crit Care,2012,18(3):280-286.
- [11]Bronicki RA.Venous oximetry and the assessment of oxygen transport balance[J].Pediatr Crit Care Med,2011,12(4 Suppl):S21-26.