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目的:观察参麦注射液对于脓毒症休克患者血流动力学的影响。方法:将2012年1月—2014年9月入住医院重症监护病房(ICU)的51例脓毒症性休克患者按随机数字表法分为治疗组(26例)和对照组(25例)。对照组接受“严重感染的集束化治疗”[2];治疗组在集束化治疗的基础上加用参麦注射液(50 m L静脉滴注,每日1次,疗程14 d)。测量患者入ICU(治疗前)以及治疗6 h、12 h、24 h以及48 h时心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、PICCO监测指标包括心指数(CI)、全心舒张末期容积指数(GEDVI)、胸腔内血容积指数(ITBVI)、血管外肺水指数(EVLWI)、全身血管阻力指数(SVRI)以及血管活性药物用量的变化,并观察患者28 d脱离呼吸机时间以及生存率。结果:两组脓毒性休克患者入院时表现为HR增快,血压降低,低CI,低SVRI以及高EVLWI等血液动力学特征。通过集束化治疗后两组患者均表现为HR减慢,血压增高,CI增加,GEDVI增加,ITBVI增加,EVLWI降低以及SVRI增高,但是参麦组在6 h以及12 h CI增加更明显以及迅速,48 h EVLWI下降较对照组明显,差异有统计学意义。参麦组患者多巴酚丁胺使用量在6 h以及12 h较对照组明显减少,去甲肾上腺素的使用量在24 h较对照组明显减少,差异有统计学意义。两组脱离呼吸机时间以及28 d生存率无明显差异。结论:参麦注射液可改善脓毒症性休克患者的血流动力学变化,减少血管活性药物的使用。
Objective: To observe the effect of Shenmai injection on hemodynamics in septic shock patients. Methods: Fifty-one patients with septic shock who admitted to intensive care unit (ICU) from January 2012 to September 2014 were randomly divided into treatment group (26 cases) and control group (25 cases). The control group received “intensive treatment of severe infection” [2]. The treatment group was treated with Shenmai injection (50 m L intravenously once daily for 14 days) on the basis of intensive treatment. Heart rate (HR), mean arterial pressure (MAP), and central venous pressure (CVP) were measured at 6 h, 12 h, 24 h and 48 h after ICU treatment (before treatment) (GEDVI), intrathoracic volume index (ITBVI), extravascular lung water index (EVLWI), systemic vascular resistance index (SVRI) and the amount of vasoactive drugs, and the patients were observed for 28 days Ventilator time and survival rate. Results: Both patients with septic shock presented with haemodynamic characteristics such as increased HR, decreased blood pressure, low CI, low SVRI, and high EVLWI at admission. After treatment, both groups showed slowed HR, elevated blood pressure, increased CI, increased GEDVI, increased ITBVI, decreased EVLWI, and increased SVRI in both groups. However, the SHG increased more significantly and rapidly at 6 and 12 h, 48 h EVLWI decreased significantly compared with the control group, the difference was statistically significant. The dosage of dobutamine in Shenmai group decreased significantly at 6 h and 12 h compared with the control group, and the dosage of norepinephrine decreased significantly at 24 h compared with the control group. The difference was statistically significant. There was no significant difference between the two groups in ventilator-free time and 28-day survival rate. Conclusion: Shenmai injection can improve hemodynamic changes in patients with septic shock and reduce the use of vasoactive drugs.