参麦注射液联合常规治疗对脓毒性休克患者的临床疗效
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摘要
目的探讨参麦注射液联合常规治疗对脓毒性休克患者的临床疗效。方法 106例患者随机分为对照组和观察组,每组53例,对照组给予常规治疗,观察组在对照组基础上加用参麦注射液,7 d为1个疗程。然后,检测临床疗效指标[急性生理和慢性健康状况评分(APACHE-Ⅱ)、全身感染相关器官功能衰竭评分(SOFA)、乳酸(LA)]、心功能评价指标[平均动脉压(MAP)、心排血量(CO)、左室射血分数(LVEF)、心脏指数(CI)、每搏输出量(SV)、心率(HR)]、肾功能评价指标[24 h尿量、尿素氮(BUN)、肌酐(Cr)、尿酸(UA)]、血清炎性反应因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、降钙素原(PCT)]变化。结果治疗后,2组临床疗效指标、HR、BUN、Cr、UA、血清炎性反应因子显著降低(P<0.01),MAP、CO、LVEF、CI、SV、24 h尿量显著升高(P<0.01),以观察组(24 h尿量除外)更明显(P<0.01)。结论参麦注射液联合常规治疗可改善脓毒性休克患者临床症状及心肾功能,降低血清炎性反应因子水平。
AIM To explore the clinical effects of Shenmai Injection combined with routine treatment on septic shock patients. METHODS One hundred and six patients were randomly divided into control group and observation group, 53 cases in each group, the control group was given routine treatment, while the observation group was added with Shenmai Injection on the basis of the control group, 7 days as a course of treatment. Subsequently, the changes in clinical efficacy indices[acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ) score, sequential organ failure assessment(SOFA) score, lactic acid(LA)], cardiac function evaluation indices[mean arterial pressure(MAP), cardiac output(CO), left ventricular ejection fraction(LVEF), cardiac index(CI), stroke volume(SV), heart rate(HR)], renal function evaluation indices[24 h urine volume, blood urea nitrogen(BUN), creatinine(Cr), uric acid(UA)] and serum inflammatory response factors[C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), procalcitonin(PCT)] were detected.RESULTS After the treatment, the two groups demonstrated significantly decreased clinical efficacy indices, HR, BUN, Cr, UA and serum inflammatory response factors(P<0.01), and markedly increased MAP, CO, LVEF, CI, SV and 24 h urine volume(P<0.01), especially for the observation group(P<0.01, except for 24 h urine volume).CONCLUSION For the septic shock patients, Shenmai Injection combined with routine treatment can improve clinical symptoms, cardiac and renal functions, and decrease serum inflammatory response factor levels.
AIM To explore the clinical effects of Shenmai Injection combined with routine treatment on septic shock patients. METHODS One hundred and six patients were randomly divided into control group and observation group, 53 cases in each group, the control group was given routine treatment, while the observation group was added with Shenmai Injection on the basis of the control group, 7 days as a course of treatment. Subsequently, the changes in clinical efficacy indices[acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ) score, sequential organ failure assessment(SOFA) score, lactic acid(LA)], cardiac function evaluation indices[mean arterial pressure(MAP), cardiac output(CO), left ventricular ejection fraction(LVEF), cardiac index(CI), stroke volume(SV), heart rate(HR)], renal function evaluation indices[24 h urine volume, blood urea nitrogen(BUN), creatinine(Cr), uric acid(UA)] and serum inflammatory response factors[C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), procalcitonin(PCT)] were detected.RESULTS After the treatment, the two groups demonstrated significantly decreased clinical efficacy indices, HR, BUN, Cr, UA and serum inflammatory response factors(P<0.01), and markedly increased MAP, CO, LVEF, CI, SV and 24 h urine volume(P<0.01), especially for the observation group(P<0.01, except for 24 h urine volume).CONCLUSION For the septic shock patients, Shenmai Injection combined with routine treatment can improve clinical symptoms, cardiac and renal functions, and decrease serum inflammatory response factor levels.
引文
[1] Esposito S, De Simone G, Boccia G, et al. Sepsis and septic shock: new definitions, new diagnostic and therapeutic approaches[J]. J Glob Antimicrob Resist, 2017, 10:204-212.
[2] Altshuler A E, Kistler E B, Schmid-Sch?nbein G W. Autodigestion: proteolytic degradation and multiple organ failure in shock[J]. Shock, 2016, 45(5):483-489.
[3] Hattori Y, Hattori K, Suzuki T, et al. Recent advances in the pathophysiology and molecular basis of sepsis-associated organ dysfunction: Novel therapeutic implications and challenges[J]. Pharmacol Ther, 2017, 177:56-66.
[4] Rivers E P, Katranji M, Jaehne K A, et al. Early interventions in severe sepsis and septic shock: a review of the evidence one decade later[J]. Minerva Anestesiol, 2012, 78(6):712-724.
[5] Polat G, Ugan R A, Cadirci E, et al. Sepsis and septic shock: Current treatment strategies and new approaches[J]. Eurasian J Med, 2017, 49(1):53-58.
[6] 中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华危重病急救医学, 2015, 27(6): 401-426.
[7] Wang H L, Xu T D, Lewin M R. Future possibilities for the treatment of septic shock with herbal components[J]. Am J Emerg Med, 2009, 27(1):107-112.
[8] 余健, 辛艳飞, 宣尧仙. 参麦注射液药理作用的物质基础研究进展[J]. 医药导报, 2013, 32(4):497-500.
[9] 钟建,魏清兰,张力,等.血乳酸清除率和APACHE Ⅱ评分在感染性休克患者中的关联性分析[J].中国医药科学,2017,7(5):184-186.
[10] 张鹏,闫波,高素珍.血清降钙素原对感染性休克的早期诊断及预后评估意义[J].实用医药杂志,2017,34(2):119-121.
[11] Suarez De La Rica A, Gilsanz F, Maseda E. Epidemiologic trends of sepsis in western countries[J]. Ann Transl Med, 2016, 4(17):325.
[12] Schultz M J, Dunser M W, Dondorp A M, et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future[J]. Intensive Care Med, 2017, 43(5):612-624.
[13] Roveran Genga K, Lo C, Cirstea M, et al. Two-year follow-up of patients with septic shock presenting with low HDL: the effect upon acute kidney injury, death and estimated glomerular filtration rate[J]. J Intern Med, 2017, 281(4 Suppl 2):518-529.
[14] Hou L C, Li S Z, Xiong L Z, et al. Effect of dopamine and metaraminol on the renal function of patients with septic shock[J].Chin Med J (Engl), 2007, 120(8):680-683.
[15] 江玲芝,汪明珊,王金柱,等.脓毒症合并急性肾损伤患者继发血小板减少症的危险因素分析[J].中华临床感染病杂志,2017,10(3):187-193.
[16] 杨文韬,苗彦,陈凝.左西孟旦联合多巴酚丁胺治疗脓毒性休克心功能障碍的疗效评价[J].中国现代医生,2016,54(27):33-35.
[17] Hardaway R M.A review of septic shock[J]. Am Surg, 2000, 66(1):22-29.
[18] Ko Y H, Ji Y S, Park S Y, et al.Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi[J]. Int Braz J Urol, 2016, 42(2):270-276.
[19] Dong W, Zhang G N, Qu F. Effects of Ringer’s sodium pyruvate solution on serum tumor necrosis factor-α and interleukin-6 upon septic shock[J]. Pak J Med Sci, 2015, 31(3):672-677.
[20] Zeng C, He F, Xia C, et al. Identification of the active components in Shenmai injection that differentially affect Cyp3a4-mediated 1′-hydroxylation and 4-hydroxylation of midazolam[J]. Drug Metab Dispos, 2013, 41(4):785-790.
[21] Yu Y H, Cui N Q, Fu Q, et al. Change of TH1/TH2 cytokine equilibrium in rats with severe sepsis and therapeutic effect of recombinant interleukin-12 and Shenmai injection[J]. Chin J Integr Med, 2005, 11(2):136-141.
[22] Liu W Y, Zhang J W, Yao X Q, et al. Shenmai injection enhances the cytotoxicity of chemotherapeutic drugs against colorectal cancers via improving their subcellular distribution[J]. Acta Pharmacol Sin, 2017, 38(2):264-276.
[23] Ye L F, Zheng Y R, Wang L H. Effects of Shenmai injection and its bioactive components following ischemia/reperfusion in cardiomyocytes[J].Exp Ther Med, 2015, 10(4):1348-1354.
[2] Altshuler A E, Kistler E B, Schmid-Sch?nbein G W. Autodigestion: proteolytic degradation and multiple organ failure in shock[J]. Shock, 2016, 45(5):483-489.
[3] Hattori Y, Hattori K, Suzuki T, et al. Recent advances in the pathophysiology and molecular basis of sepsis-associated organ dysfunction: Novel therapeutic implications and challenges[J]. Pharmacol Ther, 2017, 177:56-66.
[4] Rivers E P, Katranji M, Jaehne K A, et al. Early interventions in severe sepsis and septic shock: a review of the evidence one decade later[J]. Minerva Anestesiol, 2012, 78(6):712-724.
[5] Polat G, Ugan R A, Cadirci E, et al. Sepsis and septic shock: Current treatment strategies and new approaches[J]. Eurasian J Med, 2017, 49(1):53-58.
[6] 中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)[J]. 中华危重病急救医学, 2015, 27(6): 401-426.
[7] Wang H L, Xu T D, Lewin M R. Future possibilities for the treatment of septic shock with herbal components[J]. Am J Emerg Med, 2009, 27(1):107-112.
[8] 余健, 辛艳飞, 宣尧仙. 参麦注射液药理作用的物质基础研究进展[J]. 医药导报, 2013, 32(4):497-500.
[9] 钟建,魏清兰,张力,等.血乳酸清除率和APACHE Ⅱ评分在感染性休克患者中的关联性分析[J].中国医药科学,2017,7(5):184-186.
[10] 张鹏,闫波,高素珍.血清降钙素原对感染性休克的早期诊断及预后评估意义[J].实用医药杂志,2017,34(2):119-121.
[11] Suarez De La Rica A, Gilsanz F, Maseda E. Epidemiologic trends of sepsis in western countries[J]. Ann Transl Med, 2016, 4(17):325.
[12] Schultz M J, Dunser M W, Dondorp A M, et al. Current challenges in the management of sepsis in ICUs in resource-poor settings and suggestions for the future[J]. Intensive Care Med, 2017, 43(5):612-624.
[13] Roveran Genga K, Lo C, Cirstea M, et al. Two-year follow-up of patients with septic shock presenting with low HDL: the effect upon acute kidney injury, death and estimated glomerular filtration rate[J]. J Intern Med, 2017, 281(4 Suppl 2):518-529.
[14] Hou L C, Li S Z, Xiong L Z, et al. Effect of dopamine and metaraminol on the renal function of patients with septic shock[J].Chin Med J (Engl), 2007, 120(8):680-683.
[15] 江玲芝,汪明珊,王金柱,等.脓毒症合并急性肾损伤患者继发血小板减少症的危险因素分析[J].中华临床感染病杂志,2017,10(3):187-193.
[16] 杨文韬,苗彦,陈凝.左西孟旦联合多巴酚丁胺治疗脓毒性休克心功能障碍的疗效评价[J].中国现代医生,2016,54(27):33-35.
[17] Hardaway R M.A review of septic shock[J]. Am Surg, 2000, 66(1):22-29.
[18] Ko Y H, Ji Y S, Park S Y, et al.Procalcitonin determined at emergency department as an early indicator of progression to septic shock in patient with sepsis associated with ureteral calculi[J]. Int Braz J Urol, 2016, 42(2):270-276.
[19] Dong W, Zhang G N, Qu F. Effects of Ringer’s sodium pyruvate solution on serum tumor necrosis factor-α and interleukin-6 upon septic shock[J]. Pak J Med Sci, 2015, 31(3):672-677.
[20] Zeng C, He F, Xia C, et al. Identification of the active components in Shenmai injection that differentially affect Cyp3a4-mediated 1′-hydroxylation and 4-hydroxylation of midazolam[J]. Drug Metab Dispos, 2013, 41(4):785-790.
[21] Yu Y H, Cui N Q, Fu Q, et al. Change of TH1/TH2 cytokine equilibrium in rats with severe sepsis and therapeutic effect of recombinant interleukin-12 and Shenmai injection[J]. Chin J Integr Med, 2005, 11(2):136-141.
[22] Liu W Y, Zhang J W, Yao X Q, et al. Shenmai injection enhances the cytotoxicity of chemotherapeutic drugs against colorectal cancers via improving their subcellular distribution[J]. Acta Pharmacol Sin, 2017, 38(2):264-276.
[23] Ye L F, Zheng Y R, Wang L H. Effects of Shenmai injection and its bioactive components following ischemia/reperfusion in cardiomyocytes[J].Exp Ther Med, 2015, 10(4):1348-1354.