收稿日期: 2023-07-28
网络出版日期: 2024-03-26
基金资助
广东省社会发展领域科技计划项目(2014A020221044);广东省中医院名医工作室;国家中医药管理局第七批全国老中医药专家学术经验继承工作(国中医药人教函[2022]76号)
The effect of Xinmailong injection on microcirculation in patients with septic shock
Received date: 2023-07-28
Online published: 2024-03-26
目的 观察心脉隆注射液对脓毒症休克患者微循环的影响,以了解心脉隆对脓毒症休克患者中的应用效果与价值。 方法 选取本院重症监护室诊治的82例脓毒症休克患者为研究对象,随机分为两组,对照组的41例患者进行常规脓毒症休克集束化治疗,治疗组的41例患者在对照组集束化治疗的基础上加心脉隆注射液,比较两组治疗前、治疗后的血流动力学参数(HR、CVP、CO、MAP、SVR)、血流变(全血还原黏度、血细胞比容、纤维蛋白原、血小板聚集率)、微循环灌注指标(氧合指数、血乳酸水平、SCVO2、Pcv-aCO2)及28 d生存率。 结果 治疗前两组血流动力学参数、血流变及微循环灌注指标,差异均无统计学意义(P > 0.05);而治疗后两组的上述方面检测结果均显著改善,且治疗组的检测结果显著地好于对照组,28 d生存率亦优于对照组,差异均有统计学意义(P < 0.05)。 结论 心脉隆注射液可显著地改善脓毒症休患者的血流动力学参数,改善血流变及微循环灌注指标,提高28 d生存率。在脓毒症休克患者治疗中具有积极的临床治疗效果。
吴广平 , 尹鑫 , 何健卓 , 郭力恒 . 心脉隆注射液对脓毒症休克患者微循环的影响[J]. 实用医学杂志, 2024 , 40(5) : 627 -631 . DOI: 10.3969/j.issn.1006-5725.2024.05.007
Objective To observe the effect of Xinmailong injection on microcirculation in patients with septic shock, so as to understand the application effect and value of Xinmailong injection in patients with septic shock. Methods A total of 82 patients with septic shock treated in the intensive care unit of our hospital were selected as the research objects and randomly divided into two groups. 41 patients in the control group were treated with conventional septic shock cluster therapy, and 41 patients in the treatment group were treated with Xinmailong injection on the basis of cluster therapy in the control group. Then hemodynamic parameters (HR, CVP, CO, MAP, SVR), hemorheology (whole blood reducing viscosity, hematocrit, fibrinogen, platelet aggregation rate), microcirculation perfusion indexes (oxygenation index, blood lactate level, SCVO2, Pcv-aCO2) and 28-day survival rate were detected and compared between the two groups before and after treatment. Results Before treatment, there were no significant differences in hemodynamic parameters, blood rheology and microcirculation perfusion indexes between the two groups (P > 0.05). After treatment, the above test results of the two groups were significantly improved, and the test results of the treatment group were significantly better than those of the control group, and the 28-day survival rate was also better than that of the control group. The differences were statistically significant (P < 0.05). Conclusion Xinmailong injection can significantly improve the hemodynamic parameters, blood rheology and microcirculation perfusion indexes, and improve the 28-day survival rate of patients with sepsis. It has a positive clinical effect in the treatment of septic shock patients.
Key words: sepsis; Xinmailong injection; microcirculation; survival rates
| 1 | SINGER M, DEUTSCHMAN C S, SEYMOUR C W . et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA,2016,315(8):801-810. |
| 2 | VINCENT J L. Current sepsis therapeutics[J]. EBioMedicine,2022,86:314-318. doi:10.1016/j.ebiom.2022.104318 |
| 3 | CHIU C, LEGRAND M. Epidemiology of sepsis and septic shock [J]. Curr Opin Anaesthesiol,2021,34(2):71-76. doi:10.1097/aco.0000000000000958 |
| 4 | SACHAGL,BAUERSR,LATI. Vasoactive Agent Use in Septic Shock:Beyond First-Line Recommendations[J].Pharmacotherapy,2019,39(3):369-381. doi:10.1002/phar.2220 |
| 5 | DER-NIGOGHOSSIAN C,HAMMOND D A, AMMAR M A. Narrative Review of Controversies Involving Vasopressin Use in Septic Shock and Practical Considerations[J]. Ann Pharmacother,2020,54(7):706-714. doi:10.1177/1060028020901521 |
| 6 | FONT M D, THYAGARAJAN B, KHANNA A K. Sepsis and Septic Shock-Basics of diagnosis, pathophysiology and clinical decision making[J]. Med Clin North Am,2020,104(4):573-585. doi:10.1016/j.mcna.2020.02.011 |
| 7 | BISSELLBD, MAGEE C, MORAN P,etal.Hemodynamic Instability Secondary to Vasopressin Withdrawal in SepticShock[J]. J ntensive Care Med,2019,34(9):761-765. doi:10.1177/0885066617716396 |
| 8 | 张文娟,邵俊,吴晓燕,等. PtcO2/PtcCO2比值对脓毒性休克患者集束化治疗微循环变化的评估及预后价值分析[J].中华危重病急救医学,2019,31(12):1521-1526. |
| 9 | 任薇,梁伟,闫沁斌,等. CRRT辅助治疗脓毒性休克的临床疗效及其对血PCT与CRP的影响 [J].西部医学,2018,30(8):1207-1209. |
| 10 | KATTAN E, HERNANDEZ G. The role of peripheral perfusion markers and lactate in septic shock resuscitation[J].J Intensive Med,2021,2(1):17-21. doi:10.1016/j.jointm.2021.11.002 |
| 11 | ZENG X Y, LIAO X L, KANG Y, et al. Predictive value of early changes in sublingual microcirculation on organ failure of patients with septic shock[J]. Sichuan Da Xue Xue Bao Yi Xue Ban, 2016,47(4):574-579. |
| 12 | 黄小春. 心脉隆注射液联合常规临床干预治疗冠心病并发心力衰竭患者的效果[J]. 中外医学研究,2022, 20(28):134-137. |
| 13 | 黄颖,唐立丽,关于琳,等. 脓毒症心肌损伤发病机制及治疗研究进展[J]. 实用医学杂志,2023,39(14):1848-1852. doi:10.3969/j.issn.1006-5725.2023.14.021 |
| 14 | 李文卓,杨莉,夏婧. 心脉隆注射液对脓毒症心肌病的临床疗效观察[J]. 昆明医科大学学报, 2022,43(12):111-116. doi:10.12259/j.issn.2095-610X.S20221221 |
| 15 | 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]. 全科医学临床与教育,2015,54(4):401-426. |
| 16 | 中华医学会急诊医学分会危重病专家委员会. 脓毒症的定义、诊断标准、中医证候诊断要点及说明(草案)[J]. 中华急诊医学杂志,2007,16(8):797-798. doi:10.3760/j.issn:1671-0282.2007.08.003 |
| 17 | RUANGSOMBOON O, BOOMEE P, LIMSUWAT C, et al. The utility of the rapid emergency medicine score(REMS)compared with SIRS,qSOFA and NEWS for predicting in- hospital mortality among patients with suspicion of Sepsis in an emergency department[J]. BMC Emerg Med,2021(21):2-3. doi:10.1186/s12873-020-00396-x |
| 18 | 何怀武,刘大为,隆云. 休克复苏:“大循环-微循环”偶联的提出与内涵[J]. 中华医学会杂志,2018,98(35):2781-2784. |
| 19 | 沈延飞,蔡国龙. 脓毒症相关微循环障碍的研究进展[J]. 中华重症医学电子杂志,2020,6(2):160-164. |
| 20 | PAN P, LIU D W, SU L X, et al. Role of Combining Peripheral with Sublingual Perfusion on Evaluating Microcirculation and Predicting Prognosis in Patients with Septic Shock[J]. Chin Med J, 2018,131(10):1158-1166. doi:10.4103/0366-6999.231524 |
| 21 | 王仲,魏捷,朱华栋,等. 中国脓毒症早期预防与阻断急诊专家共识[J]. 临床急诊杂志,2020,21(7):517-529. |
| 22 | 王今达,李志军,李银平. 从“三证三法 ”辨证论治脓毒症[J].中华危重病急救医学, 2006,18(11):643-644 |
| 23 | 刘清泉. 对脓毒症中医病机特点及治法的认识[J].北京中医药,2007,26(4):198-200. |
| 24 | HE J, ZHAO X, LIN X,et al. The Effect of Xinmailong Infusion on Sepsis-Induced Myocardial Dysfunction: A Pragmatic Randomized Controlled Trial[J].Shock,2020,8(2):1001-1003. |
| 25 | 杨晰晰,曹东,田新,等. 心脉隆注射液治疗脓毒血症合并心力衰竭的临床疗效[J]. 中西医结合心脑血管病杂志,2021,19(4):647-648. doi:10.12102/j.issn.1672-1349.2021.04.031 |
| 26 | 陆元兰,岑祥莹,张炉英,等. 血小板早期变化与脓毒症所致器官功能障碍相关性[J]. 实用医学杂志,2020, 36(4):493-497. doi:10.3969/j.issn.1006-5725.2020.04.015 |
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