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目的:采用脉搏指示连续心排出量(Pi CCO)技术监测参麦注射液对脓毒性休克患者血流动力学的影响。方法:将35例中医辨证属气阴两虚证的脓毒性休克患者随机分为对照组18例和治疗组17例。两组均采用规范化西药治疗,包括早期液体复苏、抗生素治疗、控制感染源、应用血管活性药物及糖皮质激素、维持水电解质平衡、纠正酸中毒等,治疗组在此基础上加用参麦注射液100 m L静脉滴注,对照组每日加用等量的0.9%氯化钠注射液静脉滴注。应用Pi CCO技术分别于治疗前、治疗后6、12、24、48 h监测患者心脏指数(CI)、系统血管阻力指数(SVRI)、每搏量变异(SVV)、肺毛细血管通透性指数(PVPI)指标,分析两组患者血流动力学指标的变化,并比较其治疗48 h后的临床疗效。结果:治疗48 h后,总有效率治疗组为76.5%,对照组为61.1%,治疗组优于对照组(P<0.05);治疗12、24、48 h后,治疗组CI及SVRI均高于对照组(P<0.05);治疗6、12,24、48 h后,治疗组PVPI均低于对照组(P<0.05);而两组间各时段所测得SVV比较,差异均无统计学意义(P>0.05)。结论:参麦注射液在抗脓毒性休克方面有良好的疗效,其作用机制可能与增加心肌收缩力、改善外周血管阻力、降低肺毛细血管通透性有关。
Objective: To monitor the effect of Shenmai injection on hemodynamics in patients with septic shock by using PiCCO. Methods: Thirty-five patients with septic shock of qi and yin-deficiency syndrome were randomly divided into control group (n = 18) and treatment group (n = 17). Both groups were treated with standardized western medicine, including early liquid resuscitation, antibiotic treatment, control of infection source, application of vasoactive drugs and glucocorticoid, maintenance of water and electrolyte balance, and correction of acidosis. On the basis of this study, Liquid 100 m L intravenous infusion, the control group daily plus an equal amount of 0.9% sodium chloride injection intravenous infusion. PiCCO technique was used to monitor the changes of cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume variation (SVV), pulmonary capillary permeability index before treatment, 6,12,24,48 h after treatment, (PVPI) were measured to analyze the changes of hemodynamics in both groups and to compare their clinical efficacy after 48 hours of treatment. Results: After 48 h of treatment, the total effective rate was 76.5% in the treatment group and 61.1% in the control group, which was superior to the control group (P <0.05). After 12, 24 and 48 h of treatment, the CI and SVRI of the treatment group were both high (P <0.05). After 6, 12, 24 and 48 hours of treatment, the PVPI in the treatment group was lower than that in the control group (P <0.05). There was no statistical difference in the SVV between the two groups Significance (P> 0.05). Conclusion: Shenmai injection has a good curative effect in anti-septic shock. Its mechanism may be related to increasing myocardial contractility, improving peripheral vascular resistance and decreasing pulmonary capillary permeability.