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目的观察益气活血法联合连续性血液净化(CBP)治疗危重病患者的临床疗效。方法将40例危重症中医辨证为气虚血瘀证患者随机分为对照组(17例)与治疗组(23例),对照组采用连续性静脉-静脉血液滤过(CVVH)方式治疗,治疗组在对照组基础上给予参麦注射液及丹参粉针治疗,观察两组治疗前后中医证候积分、急性生理学与慢性健康状况评分Ⅱ(APACHE-Ⅱ)、凝血指标、肝素总量、平均血压(MBP)、血气分析、肾功能、细胞因子水平及中医证候疗效。结果治疗组治疗后血小板(PLT)、肝素总量、MBP均明显下降(P<0.05),且两组治疗后PLT、肝素总量差异均有统计学意义(P<0.05);两组治疗后APACHE-Ⅱ、中医证候积分均较治疗前明显降低(P<0.05),治疗组治疗后中医证候积分较对照组明显降低(P<0.05)。两组治疗后血气分析指标均较治疗前明显降低(P<0.05)。两组治疗后血尿素氮、肌酐及细胞因子水平均较治疗前明显降低(P<0.05),但组间差异无统计学意义(P>0.05)。治疗组中医证候疗效总有效率明显优于对照组(P<0.05)。结论中医益气活血法联合CBP对危重症气虚血瘀证患者有较好的临床疗效,在改善患者中医证候积分、减少肝素用量方面优于单纯CBP治疗。
Objective To observe the clinical efficacy of Yiqi Huoxue combined with continuous blood purification (CBP) in the treatment of critically ill patients. Methods Forty patients with TCM syndrome differentiation of qi deficiency and blood stasis syndrome were randomly divided into control group (n = 17) and treatment group (n = 23). The control group was treated with CVVH. The treatment group On the basis of the control group, Shenmai injection and Salvia miltiorrhiza acupuncture were given. The scores of TCM syndromes, APACHE-Ⅱ, coagulation index, heparin and mean blood pressure before and after treatment MBP), blood gas analysis, renal function, cytokine levels and TCM Syndromes curative effect. Results After treatment, PLT, total heparin, and MBP in the treatment group decreased significantly (P <0.05), and there was significant difference between the two groups in the total PLT and heparin (P <0.05) APACHE-Ⅱ and TCM syndrome scores were significantly lower than those before treatment (P <0.05). The TCM syndrome scores of the treatment group were significantly lower than those of the control group after treatment (P <0.05). Blood gas analysis index of two groups after treatment were significantly lower than before treatment (P <0.05). Blood urea nitrogen, creatinine and cytokines in both groups were significantly lower than those before treatment (P <0.05), but there was no significant difference between the two groups (P> 0.05). The total effective rate of TCM syndrome in treatment group was significantly better than that in control group (P <0.05). Conclusion TCM Yiqi Huoxue combined with CBP has better clinical curative effect on critically ill patients with qi deficiency and blood stasis syndrome. It is better than pure CBP in improving TCM syndrome score and reducing heparin dosage.