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四逆升降散对改善脓毒症毛细血管渗漏综合征无创血流动力学指标的效果

Effect of Sini Shengjiang Powder in improving non-invasive hemodynamic indexes of sepsis capillary leakage syndrome

    摘要
  • 摘要: 目的 观察四逆升降散对改善脓毒症毛细血管渗漏综合征患者无创血流动力学指标的效果。 方法 将92例受试者随机分为对照组和治疗组，每组46例。在常规治疗基础上治疗组加用四逆升降散，对照组加用四逆升降散安慰剂，2组均治疗7 d。比较2组治疗前（T0）、治疗第3天（T1）、治疗第7天（T2）受试者胸液水平（TFC），以及心输出量（CO）、心脏指数（CI）、每搏输出量（SV）、每搏指数（SI）、每搏输出量变异度（SVV）、外周血管阻力（SVR）、外周血管阻力指数（SVRI）。记录急性生理学和慢性健康状况评价Ⅱ（APACHE Ⅱ）、序贯器官衰竭估计（SOFA）评分、中医证候评分。同时，比较2组连续肾脏替代治疗（CRRT）使用率、28 d病死率和住院时间。 结果 治疗组T1和T2时点CO、CI、SV、SI与对照组比较，差异有统计学意义（P<0.05）。治疗组T2时点SVV、SVR、SVRI与对照组比较，差异有统计学意义（P<0.05）。治疗组T2时点APACHE Ⅱ评分、SOFA评分、中医证候评分与T1时点及对照组比较，差异有统计学意义（P<0.05）。治疗组CRRT使用率、28 d病死率低于对照组，住院时间短于对照组，差异均有统计学意义（P<0.05）。 结论 无创血流动力学可用于脓毒症毛细血管渗漏综合征的临床疗效评估。四逆升降散可以降低胸液水平，增强心脏泵功能，减轻患者体内液体负荷，从而稳定患者血流动力学状态，改善脓毒症毛细血管渗漏综合征患者的预后。

     

    Abstract: Objective To observe the effect of Sini Shengjiang Powder in improving non-invasive hemodynamic indexes of sepsis capillary leakage syndrome. Methods A total of 92 subjects were randomly divided into control group and treatment group, with 46 cases in each group. The treatment group was treated with Sini Shengjiang Powder on the basis of conventional treatment, and the control group was additionally treated with placebo of Sini Shengjiang Powder. The treatment lasted for 7 days. Thoracic fluid content (TFC), cardiac output (CO), cardiac index (CI), stroke volume(SV), stroke index (SI), stroke volume variation (SVV), systemic vascular resistance(SVR), systemic vascular resistance index (SVRI) before treatment (T0), on the third day(T1) and seventh day (T2) were compared. Acute physiology and chronic health score Ⅱ(APACHE Ⅱ), sequential organ failure score (SOFA) and TCM syndrome score were recorded between the two groups. The use rate of continuous renal replacement therapy (CRRT), 28 day mortality and hospital stay were compared between the two groups. Results There were significant differences in CO, CI, SV and SI at T1 and T2 between the treatment group and the control group (P<0.05). There were statistically significant differences in SVV, SVR and SVRI at T2 between the treatment group and the control group (P<0.05). The APACHE Ⅱ score, SOFA score and TCM syndrome score at T2 of the treatment group showed significant differences when compared with T1 and the control group (P<0.05). The use rate of CRRT, 28-day fatality rate in the treatment group were lower, and length of hospital stay was shorter than those in the control group (P<0.05). Conclusion Non-invasive hemodynamics can be used to evaluate the clinical efficacy of septic capillary leakage syndrome. Sini Shengjiang Powder can reduce the level of pleural fluid, enhance the function of heart pump, and reduce the fluid load in patients, so as to stabilize the hemodynamic state and improve the prognosis of patients with sepsis capillary leakage syndrome.

     

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