CAJ | 학술논문

目的探讨生脉注射液对脓毒性休克早期液体复苏患者血管外肺水及相关因素的影响.方法选取38例感染性休克患者(生脉组20例,对照组18例),两组患者均以液体复苏至患者中心静脉压(CVP)≥8mmHg作为复苏终点,并施以内科基础治疗.生脉组同时加用生脉注射液80ml,用5%葡萄糖注射液250ml稀释,1次/d.通过脉搏轮廓曲线连续心排血量监测技术监测两组患者液体复苏结束后即刻(T0)、6h(T6)、12h(T12)、24h(T24)的血管外肺水指数(EVLWI)、CVP、心排血指数(CI)、外周血管阻力指数(SVRI)、全心舒张期末容积指数(GEDVI)、胸腔内血容积指数(ITBVI)等血流动力学指标及动脉血pH值、PaO2、PaCO2和SaO2、PaO2/FiO2的变化,并记录28d病死率.结果生脉组患者T6、T12、T24时刻CI、GEDVI、ITBVI均较对照组明显增加(P<0.05或0.01),EVLWI明显降低(P<0.01);两组患者相同时点CVP、SVRI的差异均无统计学意义(均P>0.05).生脉组T12、T24时刻PaO2/FiO2均显著高于对照组(均P<0.01).生脉组患者28d病死率明显低于对照组(P<0.05).结论在液体复苏及常规治疗基础上,加用生脉注射液可以进一步降低脓毒性休克早期液体复苏时EVLWI,增加CI、GEDVI、PaO2/FiO2,可以改善休克症状、加强脏器功能保护,具有积极作用.
목적탐토생맥주사액대농독성휴극조기액체복소환자혈관외폐수급상관인소적영향.방법선취38례감염성휴극환자(생맥조20례,대조조18례),량조환자균이액체복소지환자중심정맥압(CVP)≥8mmHg작위복소종점,병시이내과기출치료.생맥조동시가용생맥주사액80ml,용5%포도당주사액250ml희석,1차/d.통과맥박륜곽곡선련속심배혈량감측기술감측량조환자액체복소결속후즉각(T0)、6h(T6)、12h(T12)、24h(T24)적혈관외폐수지수(EVLWI)、CVP、심배혈지수(CI)、외주혈관조력지수(SVRI)、전심서장기말용적지수(GEDVI)、흉강내혈용적지수(ITBVI)등혈류동역학지표급동맥혈pH치、PaO2、PaCO2화SaO2、PaO2/FiO2적변화,병기록28d병사솔.결과생맥조환자T6、T12、T24시각CI、GEDVI、ITBVI균교대조조명현증가(P<0.05혹0.01),EVLWI명현강저(P<0.01);량조환자상동시점CVP、SVRI적차이균무통계학의의(균P>0.05).생맥조T12、T24시각PaO2/FiO2균현저고우대조조(균P<0.01).생맥조환자28d병사솔명현저우대조조(P<0.05).결론재액체복소급상규치료기출상,가용생맥주사액가이진일보강저농독성휴극조기액체복소시EVLWI,증가CI、GEDVI、PaO2/FiO2,가이개선휴극증상、가강장기공능보호,구유적겁작용.
Objective To investigate the effect of Shengmai injection on extravacular lung water and related factors at the early fluid resuscitation stage of septic shock. Methods Thirty-eight patients with septic shock were randomly assigned to the treatment group(n=20) and the control group(n=18). Patients received basic treatment combined with fluid resuscitation until the central venous pressure (CVP) reached ≥8mmHg. Patients in treatment group additional y received Shengmai injection. The hemodynamic indices, including extra-vascular lung water index(EVLWI), CVP, cardiac index(CI), systemic vascular resistance index (SVRI), global end-diastolic volume index (GEDVI), intrathoracic blood volume index (ITBVI) and oxygenation index (PaO2/FiO2) were monitored at baseline(T0), 6(T6), 12(T12) and 24h(T24) after ending fluid resuscitation, and the 28d mortality was also observed. Results Compared with the control group, CI, GEDVI and PaO2/FiO2 increased significantly at T6,T12 and T24, while EVLWI and 28d mortality was decreased in the treatment group ( P<0.05 or 0.01 ). But the difference in CVP and SVRI was not statistical y significant between two groups at corresponding time points(P>0.05). Conclusion On the basis of the fluid resuscitation and basic treatment Shengmai injection can further improve CI, GEDVI, ITBVI and PaO2/FiO2, decrease EVLWI and 28-d mortality, but showed no effect on CVP or SVRI at the early fluid resuscitation stage of septic shock.