目的 探讨曲美他嗪对休克患者肾功能的影响.方法 采用前瞻性随机对照双盲研究方法,收集2011年4月到2013年4月入住广州市红十字会医院重症监护病房(ICU)的各种原因休克患者共128例,按照随机数字表法分为对照组和曲美他嗪治疗组,每组64例.两组患者均接受常规抗休克治疗方案,治疗组加用曲美他嗪20 mg口服,每日3次;对照组加用灭菌注射用水10 mL作为安慰剂,每日3次;两组均治疗7d.于治疗前、治疗后48 h、治疗后1周测定每小时尿量、血肌酐(SCr)、血尿素氮(BUN)、胱抑素C,计算肌酐清除率(CCr),同时监测患者动态平均动脉压(MAP),并记录48 h和1周病死率.结果 两组患者治疗前肾功能指标差异均无统计学意义.治疗后患者SCr、BUN、胱抑素C逐渐下降,CCr、MAP逐渐升高.与对照组比较,治疗组治疗后48 h胱抑素C下降、CCr升高差异即有统计学意义[胱抑素C(mg/L):0.85±0.81比1.01±0.91,t=2.562,P＝0.017;CCr(mL/s):0.93±0.64比0.69±0.40,t=2.155,P=0.033];治疗后1周SCr、BUN下降差异有统计学意义[SCr(μmol/L):94.23±88.31比104.99±98.37,t=2.921,P=0.003; BUN(mmol/L):9.46±8.24比11.87±8.65,t=2.611,P=0.010].两组治疗后每小时尿量、MAP均所改善,但治疗组与对照组比较差异均无统计学意义[每小时尿量(mL):治疗后48 h 55.67±31.43比45.34±11.79,t=0.934,P=0.323;治疗后1周71.67±37.23比75.35±22.88,t=1.280,P=0.210;MAP (mmHg,1 mmHg=0.133 kPa):治疗后48 h 72.13±33.24比69.28±39.98,t=1.408,P=0.179;治疗后1周71.44±21.98比72.32±31.11,t=1.184,P=0.252].治疗组病死率较对照组有所降低,但差异无统计学意义[治疗后48 h:31.2％(20/64)比32.8％(21/64),x2=0.084,P=0.785;治疗后1周:32.8％(21/64)％比35.9％(23/64),x2=2.084,P=0.173].结论 曲美他嗪可以改善休克患者的肾功能.
目的 探討麯美他嗪對休剋患者腎功能的影響.方法 採用前瞻性隨機對照雙盲研究方法,收集2011年4月到2013年4月入住廣州市紅十字會醫院重癥鑑護病房(ICU)的各種原因休剋患者共128例,按照隨機數字錶法分為對照組和麯美他嗪治療組,每組64例.兩組患者均接受常規抗休剋治療方案,治療組加用麯美他嗪20 mg口服,每日3次;對照組加用滅菌註射用水10 mL作為安慰劑,每日3次;兩組均治療7d.于治療前、治療後48 h、治療後1週測定每小時尿量、血肌酐(SCr)、血尿素氮(BUN)、胱抑素C,計算肌酐清除率(CCr),同時鑑測患者動態平均動脈壓(MAP),併記錄48 h和1週病死率.結果 兩組患者治療前腎功能指標差異均無統計學意義.治療後患者SCr、BUN、胱抑素C逐漸下降,CCr、MAP逐漸升高.與對照組比較,治療組治療後48 h胱抑素C下降、CCr升高差異即有統計學意義[胱抑素C(mg/L):0.85±0.81比1.01±0.91,t=2.562,P＝0.017;CCr(mL/s):0.93±0.64比0.69±0.40,t=2.155,P=0.033];治療後1週SCr、BUN下降差異有統計學意義[SCr(μmol/L):94.23±88.31比104.99±98.37,t=2.921,P=0.003; BUN(mmol/L):9.46±8.24比11.87±8.65,t=2.611,P=0.010].兩組治療後每小時尿量、MAP均所改善,但治療組與對照組比較差異均無統計學意義[每小時尿量(mL):治療後48 h 55.67±31.43比45.34±11.79,t=0.934,P=0.323;治療後1週71.67±37.23比75.35±22.88,t=1.280,P=0.210;MAP (mmHg,1 mmHg=0.133 kPa):治療後48 h 72.13±33.24比69.28±39.98,t=1.408,P=0.179;治療後1週71.44±21.98比72.32±31.11,t=1.184,P=0.252].治療組病死率較對照組有所降低,但差異無統計學意義[治療後48 h:31.2％(20/64)比32.8％(21/64),x2=0.084,P=0.785;治療後1週:32.8％(21/64)％比35.9％(23/64),x2=2.084,P=0.173].結論 麯美他嗪可以改善休剋患者的腎功能.
목적 탐토곡미타진대휴극환자신공능적영향.방법 채용전첨성수궤대조쌍맹연구방법,수집2011년4월도2013년4월입주엄주시홍십자회의원중증감호병방(ICU)적각충원인휴극환자공128례,안조수궤수자표법분위대조조화곡미타진치료조,매조64례.량조환자균접수상규항휴극치료방안,치료조가용곡미타진20 mg구복,매일3차;대조조가용멸균주사용수10 mL작위안위제,매일3차;량조균치료7d.우치료전、치료후48 h、치료후1주측정매소시뇨량、혈기항(SCr)、혈뇨소담(BUN)、광억소C,계산기항청제솔(CCr),동시감측환자동태평균동맥압(MAP),병기록48 h화1주병사솔.결과 량조환자치료전신공능지표차이균무통계학의의.치료후환자SCr、BUN、광억소C축점하강,CCr、MAP축점승고.여대조조비교,치료조치료후48 h광억소C하강、CCr승고차이즉유통계학의의[광억소C(mg/L):0.85±0.81비1.01±0.91,t=2.562,P＝0.017;CCr(mL/s):0.93±0.64비0.69±0.40,t=2.155,P=0.033];치료후1주SCr、BUN하강차이유통계학의의[SCr(μmol/L):94.23±88.31비104.99±98.37,t=2.921,P=0.003; BUN(mmol/L):9.46±8.24비11.87±8.65,t=2.611,P=0.010].량조치료후매소시뇨량、MAP균소개선,단치료조여대조조비교차이균무통계학의의[매소시뇨량(mL):치료후48 h 55.67±31.43비45.34±11.79,t=0.934,P=0.323;치료후1주71.67±37.23비75.35±22.88,t=1.280,P=0.210;MAP (mmHg,1 mmHg=0.133 kPa):치료후48 h 72.13±33.24비69.28±39.98,t=1.408,P=0.179;치료후1주71.44±21.98비72.32±31.11,t=1.184,P=0.252].치료조병사솔교대조조유소강저,단차이무통계학의의[치료후48 h:31.2％(20/64)비32.8％(21/64),x2=0.084,P=0.785;치료후1주:32.8％(21/64)％비35.9％(23/64),x2=2.084,P=0.173].결론 곡미타진가이개선휴극환자적신공능.
Objective To investigate the effects of trimetazidine on renal function in patients with shock.Methods A prospective randomized controlled double-blind study was conducted.128 patients with shock admitted to intensive care unit (ICU) of Guangzhou Red Cross Hospital from April 2011 to April 2013 were enrolled and randomly divided into control group and trimetazidine treatment group,each n＝64.All patients received anti-shock treatment,while the patients in trimetazidine group received trimetazidine treatment (20 mg orally,tid) for 7 days,and patients in control group received placebo (10 mL of sterile water for injection,tid) for 7 days.The urinary output,serum creatinine (SCr),blood urea nitrogen (BUN),cystatin C,and creatinine clearance (CCr) reflecting renal function were recorded in both groups,and the values were compared before treatment,48 hours after treatment,and 1 week after the treatment.At the same time,dynamic mean arterial pressure (MAP) was monitored,and 48-hour and 1-week mortality rates were recorded.Results There was no significant difference in results in all the renal function parameters before the treatment between two groups.The levels of SCr,BUN,cystatin C were gradually decreased after treatment in both groups,but CCr and MAP were gradually increased.Compared with the control group,cystatin C at 48 hours after treatment was significantly decreased,while CCr was significantly increased in treatment group [cystatin C (mg/L):0.85 ± 0.81 vs.1.01 ± 0.91,t=2.562,P=0.017; CCr (mL/s):0.93 ± 0.64 vs.0.69 ± 0.40,t=2.155,P=0.033].SCr and BUN at 1 week after treatment were significantly decreased in treatment group [SCr (lμmol/L):94.23 ± 88.31 vs.104.99 ± 98.37,t=2.921,P=0.003 ; BUN (mmol/L):9.46 ± 8.24 vs.11.87 ± 8.65,t=2.611,P=0.010].Urine output per hour and MAP was improved after treatment in both groups,and no significant difference was found between treatment group and control group [urine output (mL):48 hours after treatment 55.67 ± 31.43 vs.45.34 ± 11.79,t =0.934,P=0.323 ; 1 week after treatment 71.67 ± 37.23 vs.75.35 ± 22.88,t=1.280,P=0.210; MAP (mmHg,1 mmHg=0.133 kPa):48 hours after treatment 72.13 ± 33.24 vs.69.28 ± 39.98,t=1.408,P=0.179; 1 week after treatment 71.44 ± 21.98 vs.72.32 ± 31.11,t =1.184,P =0.252].Mortality rate in treatment group was lowered compared with control group,however no statistical significance was found [48 hours after treatment:31.2％ (20/64) vs.32.8％ (21/64),x2=0.084,P=0.785; 1 week after treatment:32.8％ (21/64) vs.35.9％ (23/64),x2=2.084,P=0.173].Conclusions Trimetazidine can improve renal function in patients with shock.
