【摘要】 目的:观察参麦注射液对于脓毒症休克患者血流动力学的影响。方法:将2012年1月—2014年9月入住医院重症监护病房(ICU)的51例脓毒症性休克患者按随机数字表法分为治疗组(26例)和对照组(25例)。对照组接受"严重感染的集束化治疗"[2];治疗组在集束化治疗的基础上加用参麦注射液(50 m L静脉滴注,每日1次,疗程14 d)。测量患者入ICU(治疗前)以及治疗6 h、12 h、24 h以及48 h时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、PICCO监测指标包括心指数(CI)、全心舒张末期容积指数(GEDVI)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)、全身血管阻力指数(SVRI)以及血管活性药物用量的变化,并观察患者28 d脱离呼吸机时间以及生存率。结果:两组脓毒性休克患者入院时表现为HR增快,血压降低,低CI,低SVRI以及高EVLWI等血液动力学特征。通过集束化治疗后两组患者均表现为HR减慢,血压增高,CI增加,GEDVI增加,ITBVI增加,EVLWI降低以及SVRI增高,但是参麦组在6 h以及12 h CI增加更明显以及迅速,48 h EVLWI下降较对照组明显,差异有统计学意义。参麦组患者多巴酚丁胺使用量在6 h以及12 h较对照组明显减少,去甲肾上腺素的使用量在24 h较对照组明显减少,差异有统计学意义。两组脱离呼吸机时间以及28 d生存率无明显差异。结论:参麦注射液可改善脓毒症性休克患者的血流动力学变化,减少血管活性药物的使用。更多还原

【Abstract】 Objective: To investigate the effects of Shenmai injection on hemodynamic measurements for patients with septic shock. Methods: From Jan 2012 to Sep 2014,51 patients with septic shock admitted in Intense Care Unit( ICU)were divided into the treatment group( 26 cases) and the control group( 25 cases) according to the number randomization. The control group received the sepsis bundle therapy and the treatment group received the bundle plus Shenmai injection( 50 m L once a day for 14 days). On the day of admission to ICU( before treatment),6 h,12 h,24 h and 48 h after the treatment,heart rate( HR),mean artery pressure( MAP),central venous pressure( CVP),the data of pulse indicator continuous cardiac output( PICCO) including cardiac index( CI),global end- diastolic volume index( GEDVI),intrathoracic blood volume index( ITBVI),extravascular lung water index( EVLWI),and systemic vascular resistance index( SVRI),and the doses of vasoactive agents were observed. Results: Two groups showed similar hemodynamic features,such as increased HR,decreased blood pressure,low CI,low SVRI and high EVLWI. Two groups exhibited resembling hemodynamic features such as decreased HR,increased blood pressure,elevated CI,raised GEDVI,heightened ITBVI,reduced EVLWI and high SVRI,however,the Shenmai group demonstrated significantly higher CI on 6 and 12 hours after the treatment and lower EVLWI on 48 hours,compared with the control group. Furthermore,the Shenmai group was administrated substantially less dobutamine on 6 hours and 12 hours,and less norepinephrine on 24 hours,compared with the control group. There was no difference between two groups in days of free of mechanical ventilation and 28- day survival rate. Conclusions: Shenmai injection could improve the hemodynamic status of patients with septic shock and reduce the dose of vasoactive agents.更多还原