參附注射液治療膿毒癥患者撤機相關(guān)性肺水腫的效果

摘要： 目的探討參附注射液治療膿毒癥患者撤機相關(guān)性肺水腫的臨床效果及對脈廓指示連續(xù)心輸出量監(jiān)測(Pi CCO)中心指數(shù)(CI)、血管外肺水指數(shù)(EVLWI)、肺血管通透性指數(shù)(PVPI)的影響。方法選擇重癥醫(yī)學科收治的膿毒癥合并急性呼吸窘迫綜合征擬行撤機治療的患者40例,采用隨機數(shù)字表法分為觀察組和對照組,每組20例。對照組僅采用常規(guī)治療方法,觀察組在常規(guī)治療方法基礎上加用參附注射液治療,比較兩組患者臨床療效,同時檢測治療前及治療2、24、72 h后CI、EVLWI、PVPI。結(jié)果治療后觀察組撤機成功率(75%)高于對照組(40%)(P <0. 05),觀察組和對照組治療前后CI水平分別為(3. 355±0. 459) L/(min·m~2) vs.(3. 407±0. 386) L/(min·m~2),(3. 908±0. 383) L/(min·m~2) vs (3. 383±0. 362) L/(min·m~2),(4. 018±0. 457) L/(min·m~2) vs (3. 392±0. 344) L/(min·m~2),(4. 025±0. 481) L/(min·m~2) vs (3. 544±0. 291) L/(min·m~2);觀察組治療后CI水平升高,與治療前相比以及與對照組相比差異均有統(tǒng)計學意義(P <0. 05)。觀察組和對照組EVLWI水平治療前后分別為(10. 900±2. 654) mL/kg vs (10. 250±2. 826) mL/kg,(8. 650±1. 663) mL/kg vs (11. 350±2. 870) mL/kg,(9. 000±1. 717) mL/kg vs (10. 250±2. 124) mL/kg,(7. 800±1. 673) mL/kg vs (8. 950±2. 605) mL/kg;觀察組和對照組PVPI水平治療前后分別為3. 075±0. 485vs 3. 200±0. 736,2. 250±0. 861 vs 3. 220±0. 594,2. 320±0. 827 vs 2. 905±0. 683,2. 495±0. 788 vs 3. 070±0. 806。觀察組治療后EVLWI和PVPI水平下降,與治療前相比以及與對照組相比差異有統(tǒng)計學意義(P <0. 05)。結(jié)論聯(lián)用參附注射液治療能提高膿毒癥合并撤機相關(guān)性肺水腫患者的心輸出量,減輕肺血管的通透性,減輕肺水腫,從而提高撤機成功率。
Objective To investigate the clinical effect of Shen-Fu Injection in the treatment of patients with sepsis associated with weaning-induced pulmonary edema. Methods Patients with sepsis combined with acute respiratory distress syndrome treated in this hospital were selected for weaning treatment. A random number table was used for randomization. The control group only used conventional treatment. The study group was treated with Shen-Fu Injection on the basis of conventional treatment. The clinical efficacy was compared between the two groups,and the extravascular lung water was measured before and 2 h,24 h,and 72 h after treatment. Extravascular lung water index( EVLWI),pulmonary vascular permeability index( PVPI) and cardiac index( CI) were recorded for comparison. Results After the treatment,the success rate of weaning in the study group( 75%) was significantly higher than that in the control group( 40%)( P <0. 05). The CI level before and 2 h,24 h,and 72 h after treatment in the study group and the control group were( 3. 355 ±0. 459) L/( min·m~2) vs.( 3. 407 ± 0. 386) L/( min·m~2),( 3. 908 ± 0. 383) L/( min·m~2) vs.( 3. 383 ± 0. 362) L/( min·m~2),( 4. 018 ± 0. 457) L/( min·m~2) vs.( 3. 392 ± 0. 344) L/( min·m~2),and( 4. 025 ± 0. 481) L/( min·m~2) vs.( 3. 544 ± 0. 291) L/( min·m~2),respectively; CI levels were significantly increased after treatment in the study group,compared with before treatment or with the control group( P < 0. 05). The levels of EVLWI before and 2 h,24 h,and 72 h after treatment were( 10. 900 ± 2. 654) mL/kg vs.( 10. 250 ± 2. 826) mL/kg,( 8. 650 ± 1. 663) mL/kg vs.( 11. 350 ± 2. 870) mL/kg,( 9. 000 ± 1. 717) mL/kg vs.( 10. 250 ± 2. 124) mL/kg,( 7. 800 ± 1. 673) mL/kg vs.( 8. 950 ± 2. 605) mL/kg,respectively. The levels of PVPI before and 2 h,24 h,and 72 h after treatment in study group and control group were 3. 075 ± 0. 485 vs. 3. 200 ± 0. 736,2. 250 ± 0. 861 vs. 3. 220 ± 0. 594,2. 320 ± 0. 827 vs. 2. 905± 0. 683,and 2. 495 ± 0. 78 vs. 3. 070 ± 0. 806,respectively. After treatment,the EVLWI and PVPI levels in the study group were significantly reduced compared with before treatment or with the control group( P < 0. 05). Conclusion The combination of Shen-Fu Injection can improve the cardiac output of patients with sepsis combined with weaning-induced pulmonary edema.