五参汤联合乌司他丁对感染性休克后肺毛细血管渗漏综合征患者肺氧合功能、促炎-抗炎系统、氧化-抗氧化系统失衡的影响
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摘要
目的观察五参汤联合乌司他丁对感染性休克后肺毛细血管渗漏综合征(CLS)患者肺氧合功能、促炎-抗炎系统、氧化-抗氧化系统失衡的影响。方法将60例感染性休克后肺CLS患者随机分为观察组和对照组,每组各30例;对照组给予乌司他丁治疗,观察组在对照组的基础上加用五参汤治疗。观察2组治疗期间血流动力学、肺氧合功能、呼吸力学、炎症和氧化应激相关指标的变化,记录2组临床预后和结局情况。结果 2组治疗后6 h、12 h、24 h、48 h血流动力学参数显著改善(P均<0.05),且观察组治疗后24 h、48 h以上指标恢复情况明显优于对照组(P均<0.05);2组治疗后1 d、3 d、5 d的肺氧合指标、血管外肺水指数(EVLWI)和肺血管通透指数(PVPI)、呼吸力学参数、炎症反应和氧化应激指标均显著改善(P均<0.05),观察组以上时间点的此类指标改善情况均明显优于对照组(P均<0.05)。2组治疗后SOFA评分、APACHEⅡ评分、Murray肺损伤评分均显著降低(P均<0.05),观察组治疗后以上评分均明显低于对照组(P均<0.05)。观察组机械通气时间、住院时间、血培养转阴时间、胸部体征恢复正常时间、日均补液量、日均去甲肾上腺素用量、病死率均明显短于或低于对照组(P均<0.05)。结论五参汤联合乌司他丁可稳定感染性休克后CLS患者血流动力学,改善肺毛细血管通透性、肺氧合功能和呼吸力学参数,降低病死率,改善预后,其机制可能与促进机体促炎-抗炎、氧化-抗氧化系统平衡有关。
Objective It is to observe the effects of Wushen Decoction combined with ulinastatin on pulmonary oxygenation, proinflammatory-anti-inflammatory system and oxidation-antioxidant system imbalance in patients with pulmonary capillary leakage syndrome(CLS) after septic shock. Methods Sixty patients with pulmonary CLS after septic shock were randomly divided into observation group and control group, 30 cases in each group. The control group was treated with ulinastatin, and the observation group was treated with Wushen decoction on the basis of the control group. The Changes of hemodynamics, pulmonary oxygenation, respiratory mechanics, inflammation, and oxidative stress were observed during treatment periods. The clinical outcomes and outcomes of the two groups were recorded. Results The indicators of hemodynamics at 6 h, 12 h, 24 h and 48 h after treatment were significantly improved in the two groups, the recovery of the above indexes at 24 h and 48 h in the observation group was significantly better than that of the control group(P<0.05). The indexes of pulmonary oxygenation, extravascular lung water index(EVLWI), and pulmonary vascular permeability index(PVPI), respiratory mechanics parameters inflammation, and oxidative stress at 1 d, 3 d, and 5 d after treatment were significantly improved compared with those before treatment in the two groups, the improvement of such indicators at the time point in the observation group was better than that of the control group(P<0.05). After treatment, the SOFA score, APACH EII score and Murray lung injury score were significantly decreased in the two groups, the above scores of the observation group were lower than those in the control group. The mechanical ventilation time, hospitalization time, blood culture conversion time, chest signs recovery time, daily average fluid volume, daily norepinephrine dosage, and mortality in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Wushen decoction combined with ulinastatin can stabilize hemodynamics in patients with CLS after septic shock, improve pulmonary capillary permeability, improve pulmonary oxygenation and respiratory mechanics parameters, reduce mortality and improve prognosis. The mechanism is related to promoting the body's pro-inflammatory-anti-inflammatory, oxidative-antioxidant system balance.
Objective It is to observe the effects of Wushen Decoction combined with ulinastatin on pulmonary oxygenation, proinflammatory-anti-inflammatory system and oxidation-antioxidant system imbalance in patients with pulmonary capillary leakage syndrome(CLS) after septic shock. Methods Sixty patients with pulmonary CLS after septic shock were randomly divided into observation group and control group, 30 cases in each group. The control group was treated with ulinastatin, and the observation group was treated with Wushen decoction on the basis of the control group. The Changes of hemodynamics, pulmonary oxygenation, respiratory mechanics, inflammation, and oxidative stress were observed during treatment periods. The clinical outcomes and outcomes of the two groups were recorded. Results The indicators of hemodynamics at 6 h, 12 h, 24 h and 48 h after treatment were significantly improved in the two groups, the recovery of the above indexes at 24 h and 48 h in the observation group was significantly better than that of the control group(P<0.05). The indexes of pulmonary oxygenation, extravascular lung water index(EVLWI), and pulmonary vascular permeability index(PVPI), respiratory mechanics parameters inflammation, and oxidative stress at 1 d, 3 d, and 5 d after treatment were significantly improved compared with those before treatment in the two groups, the improvement of such indicators at the time point in the observation group was better than that of the control group(P<0.05). After treatment, the SOFA score, APACH EII score and Murray lung injury score were significantly decreased in the two groups, the above scores of the observation group were lower than those in the control group. The mechanical ventilation time, hospitalization time, blood culture conversion time, chest signs recovery time, daily average fluid volume, daily norepinephrine dosage, and mortality in the observation group were significantly lower than those in the control group(P<0.05). Conclusion Wushen decoction combined with ulinastatin can stabilize hemodynamics in patients with CLS after septic shock, improve pulmonary capillary permeability, improve pulmonary oxygenation and respiratory mechanics parameters, reduce mortality and improve prognosis. The mechanism is related to promoting the body's pro-inflammatory-anti-inflammatory, oxidative-antioxidant system balance.
引文
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[15]林朱森,王金鹏,刘树元,等.乌司他丁对严重脓毒症和感染性休克患者氧化应激水平的影响[J].中国急救复苏与灾害医学杂志,2016,11(4):383-385
[16]温德良,李智博,温艺超,等.乌司他丁对肺外源ARDS患者肺毛细血管通透性及呼吸功能的影响[J].实用医学杂志,2016,32(14):2396-2398
[17]刁敏锐,高兰姣,左文忠,等.黄芪甲苷对失血性休克后大鼠肺损伤及炎性反应的影响[J].中华实验外科杂志,2016,33(6):1601-1603
[18]张俊光,黄东华.芪参活血颗粒对肺炎合并脓毒症患儿炎症反应的影响及脏器功能的保护作用[J].中国妇幼保健,2017,32(16):3847-3850
[19]张碎虎,才子全,杨永良,等.丹参多酚酸盐对脓毒血症性休克病人血乳酸和炎症因子浓度的影响[J].中西医结合心脑血管病杂志,2017,15(23):3051-3052
[20]乔永莉.丹参多酚酸联合乌司他丁治疗急性呼吸窘迫综合征的疗效及对患者生化指标的影响[J].中国药师,2016,19(9):1713-1715
[2]李旭,陈岩,白雪松,等.中药治疗急性肺损伤/急性呼吸窘迫综合征作用机制研究进展[J].辽宁中医药大学学报,2017,19(1):166-170
[3]Rhodes A,Evans LE,Alhazzani W,et al.Surviving Sepsis Campaign:International Guidelines for Management of Sepsis and Septic Shock:2016[J].Critical Care Medicine,2017,45(3):486-552
[4]夏海娜,王璐,张超,等.感染性休克患者血必净治疗对血乳酸、降钙素原、C-反应蛋白及血流动力学的影响研究[J].中华医院感染学杂志,2016,26(15):3378-3380
[5]颜友春,胡瑞兰.去甲肾上腺素与多巴胺改善感染性休克血流动力学及氧代谢的效果比较[J].现代诊断与治疗,2016,27(13):2420-2421
[6]李云峰,李桂成,唐湘红,等.丙泊酚镇静对严重脓毒症及脓毒症休克患者呼吸力学及氧合的影响[J].中外医疗,2011,30(29):5-6
[7]马焕先,史宪杰,梁雨荣,等.脓毒症合并全身性毛细血管渗漏综合征的诊疗分析[J].中华外科杂志,2017,55(9):702-707
[8]周静,黎毅敏.血管外肺水:重症临床应用进展[J].中华重症医学电子杂志,2016,2(2):132-136
[9]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].中华内科杂志,2015,54(6):401-426
[10]叶聪,汪燕,赵昌云.感染性休克患者炎性因子、血小板参数水平的检测及对预后判断的意义[J].中国卫生检验杂志,2017,27(4):549-551
[11]庞天舒,丁国平,阙日升,等.急危重症氧化应激及微循环障碍的研究进展[J].中华急诊医学杂志,2013,22(5):553-555
[12]钟伟州,刘青山,欧远通,等.脓毒症患者休克指数与炎症反应、氧化应激反应、靶器官损伤的相关性研究[J].海南医学院学报,2017,23(4):464-466
[13]路艳,王立维,计金华,等.羟乙基淀粉130.4电解质注射液对感染性休克患者凝血功能氧化应激反应及血流动力学的影响[J].河北医学,2017,23(6):962-965
[14]吕丁丁,金明根.乌司他丁在急危重症中的临床应用及展望[J].吉林医学,2015,36(4):740-741
[15]林朱森,王金鹏,刘树元,等.乌司他丁对严重脓毒症和感染性休克患者氧化应激水平的影响[J].中国急救复苏与灾害医学杂志,2016,11(4):383-385
[16]温德良,李智博,温艺超,等.乌司他丁对肺外源ARDS患者肺毛细血管通透性及呼吸功能的影响[J].实用医学杂志,2016,32(14):2396-2398
[17]刁敏锐,高兰姣,左文忠,等.黄芪甲苷对失血性休克后大鼠肺损伤及炎性反应的影响[J].中华实验外科杂志,2016,33(6):1601-1603
[18]张俊光,黄东华.芪参活血颗粒对肺炎合并脓毒症患儿炎症反应的影响及脏器功能的保护作用[J].中国妇幼保健,2017,32(16):3847-3850
[19]张碎虎,才子全,杨永良,等.丹参多酚酸盐对脓毒血症性休克病人血乳酸和炎症因子浓度的影响[J].中西医结合心脑血管病杂志,2017,15(23):3051-3052
[20]乔永莉.丹参多酚酸联合乌司他丁治疗急性呼吸窘迫综合征的疗效及对患者生化指标的影响[J].中国药师,2016,19(9):1713-1715