中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
12期
1383-1387
,共5页
路晓光%康新%战丽彬%于健%杨荣利%范治伟%肖威强%李思瑶%梁正凯
路曉光%康新%戰麗彬%于健%楊榮利%範治偉%肖威彊%李思瑤%樑正凱
로효광%강신%전려빈%우건%양영리%범치위%초위강%리사요%량정개
失血性休克%急性肺损伤%大黄附子汤%内毒素%血管外肺水%静态肺顺应性%呼吸道阻力%病死率%患者
失血性休剋%急性肺損傷%大黃附子湯%內毒素%血管外肺水%靜態肺順應性%呼吸道阻力%病死率%患者
실혈성휴극%급성폐손상%대황부자탕%내독소%혈관외폐수%정태폐순응성%호흡도조력%병사솔%환자
Hemorrhagic shock%Acute lung injury%DaHuang Fuzi Decoction%Endotoxin%Extravascular lung water%Static lung compliance%Airway resistance%Mortality%Patient
目的 探讨大黄附子汤防治失血性休克并发急性肺损伤的保护作用及其机理.方法 采用前瞻性、多中心、随机对照临床试验.收集2010年6月至2013年4月大连地区3所三级甲等医院87例失血性休克并发急性肺损伤患者的临床资料,采用随机数字法分为对照组(n=42)和大黄附子汤灌肠组(试验组,n=45).于患者入组时及治疗1、3、7d分别取静脉血测定肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、血乳酸、内毒素质量浓度;测定血管外肺水指数(EVLWI)、EVLW/ITBV(胸腔内总血容量)、平均动脉压(MAP)、心脏指数(CI);测定静态肺顺应性、呼吸道阻力以及呼吸机撤离时间、低氧血症纠正时间,计算患者病死率.采用SPSS 17.0软件分析实验数据,组内比较采用方差分析,两两比较采用LSD-t检验.结果 与对照组比较,试验组在大黄附子汤治疗后各时间点血清TNF-α、CRP、内毒素、血乳酸、EVLWI及EVLW/ITBV显著降低(P＜0.05或P＜0.01).与对照组比较,试验组静态肺顺应性在大黄附子汤治疗3、7d后明显增强(P＜0.01),气道阻力则在治疗7d后有所降低(P＜0.05).对照组与试验组比较,呼吸机撤离时间[(7.82±1.54)d vs.(5.26±1.28)d,P＜0.05、低氧血症纠正时间[(82.42±14.61)h vs.(62.34±11.27)h,P＜0.01]、住院时间[(13.85±2.94) dvs.(10.57±2.05)d,P＜0.05]、病死率(7.5％vs.2.5％,P＜0.01).结论 大黄附子汤通过降低肠源性内毒素和促炎因子TNF-α的释放,降低血管外肺水和呼吸道阻力,提高静态肺顺应性,改善机体氧合指数,进而缩短呼吸机撤离时间和低氧纠正时间,降低失血性休克并急性肺损伤患者的病死率.
目的 探討大黃附子湯防治失血性休剋併髮急性肺損傷的保護作用及其機理.方法 採用前瞻性、多中心、隨機對照臨床試驗.收集2010年6月至2013年4月大連地區3所三級甲等醫院87例失血性休剋併髮急性肺損傷患者的臨床資料,採用隨機數字法分為對照組(n=42)和大黃附子湯灌腸組(試驗組,n=45).于患者入組時及治療1、3、7d分彆取靜脈血測定腫瘤壞死因子α(TNF-α)、C反應蛋白(CRP)、血乳痠、內毒素質量濃度;測定血管外肺水指數(EVLWI)、EVLW/ITBV(胸腔內總血容量)、平均動脈壓(MAP)、心髒指數(CI);測定靜態肺順應性、呼吸道阻力以及呼吸機撤離時間、低氧血癥糾正時間,計算患者病死率.採用SPSS 17.0軟件分析實驗數據,組內比較採用方差分析,兩兩比較採用LSD-t檢驗.結果 與對照組比較,試驗組在大黃附子湯治療後各時間點血清TNF-α、CRP、內毒素、血乳痠、EVLWI及EVLW/ITBV顯著降低(P＜0.05或P＜0.01).與對照組比較,試驗組靜態肺順應性在大黃附子湯治療3、7d後明顯增彊(P＜0.01),氣道阻力則在治療7d後有所降低(P＜0.05).對照組與試驗組比較,呼吸機撤離時間[(7.82±1.54)d vs.(5.26±1.28)d,P＜0.05、低氧血癥糾正時間[(82.42±14.61)h vs.(62.34±11.27)h,P＜0.01]、住院時間[(13.85±2.94) dvs.(10.57±2.05)d,P＜0.05]、病死率(7.5％vs.2.5％,P＜0.01).結論 大黃附子湯通過降低腸源性內毒素和促炎因子TNF-α的釋放,降低血管外肺水和呼吸道阻力,提高靜態肺順應性,改善機體氧閤指數,進而縮短呼吸機撤離時間和低氧糾正時間,降低失血性休剋併急性肺損傷患者的病死率.
목적 탐토대황부자탕방치실혈성휴극병발급성폐손상적보호작용급기궤리.방법 채용전첨성、다중심、수궤대조림상시험.수집2010년6월지2013년4월대련지구3소삼급갑등의원87례실혈성휴극병발급성폐손상환자적림상자료,채용수궤수자법분위대조조(n=42)화대황부자탕관장조(시험조,n=45).우환자입조시급치료1、3、7d분별취정맥혈측정종류배사인자α(TNF-α)、C반응단백(CRP)、혈유산、내독소질량농도;측정혈관외폐수지수(EVLWI)、EVLW/ITBV(흉강내총혈용량)、평균동맥압(MAP)、심장지수(CI);측정정태폐순응성、호흡도조력이급호흡궤철리시간、저양혈증규정시간,계산환자병사솔.채용SPSS 17.0연건분석실험수거,조내비교채용방차분석,량량비교채용LSD-t검험.결과 여대조조비교,시험조재대황부자탕치료후각시간점혈청TNF-α、CRP、내독소、혈유산、EVLWI급EVLW/ITBV현저강저(P＜0.05혹P＜0.01).여대조조비교,시험조정태폐순응성재대황부자탕치료3、7d후명현증강(P＜0.01),기도조력칙재치료7d후유소강저(P＜0.05).대조조여시험조비교,호흡궤철리시간[(7.82±1.54)d vs.(5.26±1.28)d,P＜0.05、저양혈증규정시간[(82.42±14.61)h vs.(62.34±11.27)h,P＜0.01]、주원시간[(13.85±2.94) dvs.(10.57±2.05)d,P＜0.05]、병사솔(7.5％vs.2.5％,P＜0.01).결론 대황부자탕통과강저장원성내독소화촉염인자TNF-α적석방,강저혈관외폐수화호흡도조력,제고정태폐순응성,개선궤체양합지수,진이축단호흡궤철리시간화저양규정시간,강저실혈성휴극병급성폐손상환자적병사솔.
Objective To discuss protective effect of DaHuang Fuzi Decoction (a Chinese herbal preparation made of Rheum palmatum L and Aconitum carmichaeli Debx) on hemorrhagic shock induced by acute lung injury in patients.Methods A prospective,muhiple-center,randomized (random number) and controlled clinical trial was carried out in 87 adult patients with hemorrhagic shock secondary to acute lung injury admitted in intensive care unit (ICU) of 3 tertiary care hospitals in Dalian city.Patients were randomly (random number) divided into control group (n =42) and DaHuang Fuzi Decoction enemas group (experimental group,n =45).Of 42 patients of control group,there were 28 male and 14 female with average age (39.68 ± 15.77) years ranged from 20 to 64 years,and in experimental group,there were 30 male and 15 female with average age (42.12 ± 14.87) years ranged from 20 to 68 years.The serum levels of TNF-α,C-reactive protein (CRP),lactic acid and endotoxin,and extravascular lung water index,ratio of extravascular lung water to intrathoracic blood volume (EVLW/ITBV),MAP,cardiac index (CI),and static lung compliance and airway resistance were determined in each group before and 1d,3d,7d after treatment.The data including the length of time consumed for respiration support with mechanical ventilation and length of time required for correction of hypoxemia to normal oxygenation resumed and length of hospital stay and mortality were analyzed.Results Compared with control group,DaHuang Fuzi Decoction decreased the levels of serum TNF-α,CRP,blood lactic acid,endotoxin,VLWI and EVLW/ ITBV in experimental group (P ＜ 0.05 or P ＜ 0.01).Static lung compliance in experimental group were enhanced on 3 d,7 d after treatment,but 7 days after treatment with DaHuang Fuzi Decoction,the airway resistance in experiment group were lower than that in control group on 7 day without DaHuang Fuzi Decoction treatment.Compared with control group,in experimental group,the length of time consumed for mechanical ventilation support was ([(7.82 ± 1.54) d vs.(5.26 ± 1.28) d,P ＜ 0.05],the length of time required for restoration of normo-oxemia was [(82.42 ± 14.61) h vs.(62.34 ± 11.27) h,P ＜ 0.01],length of hospital stay was [(13.85 ±2.94) d vs.(10.57 ±2.05) d,P ＜0.05] and mortality was (7.5％ vs.2.5％,P ＜ 0.01).Conclusions DaHuang Fuzi Decoction could reduce extravascular lung water index and airway resistance,enhance static lung compliance,improve oxygenation index by inhibiting enterogenous endotoxin and TNF-α,and then shorten the mechanical ventilation support time and normal oxygenation restoration time,and reduce mortality of hemorrhagic shock induced by acute lung injury in patients.
