CAJ | 학술논문

目的：分析疏血通注射液对脓毒性休克患者微循环的影响及治疗效果。方法采用前瞻性研究方法。将河北省中医院重症医学科收治的80例脓毒性休克患者按随机数字表法分为疏血通组和常规治疗组，每组40例。两组患者均按照脓毒性休克指南推荐的方法进行积极的液体复苏和抗感染等常规治疗；疏血通组在常规治疗基础上给予疏血通注射液6 mL加5%葡萄糖注射液250 mL静脉滴注（静滴），每日1次，共用7 d。观察两组患者治疗前后的尿量、乳酸（Lac）、尿素氮（BUN）、肌酐（Cr）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、左室射血分数（LVEF）、心排血指数（CI）。记录两组多巴胺、多巴酚丁胺、去甲肾上腺素等血管活性药物的总用量和28 d病死率。结果两组治疗前尿量、Lac、BUN、Cr、AST、ALT、LVEF、CI水平比较差异均无统计学意义（均P＞0.05）；两组治疗后尿量、LVEF、CI均较治疗前增加，Lac、BUN、Cr、AST、ALT均较治疗前明显降低，且以疏血通组变化更显著〔尿量（mL/h）：112.1±39.8比73.3±28.5，LVEF：0.49±0.15比0.44±0.14，CI（mL·s-1·m-2）：66.2±5.7比54.2±6.2，Lac（mmol/L）：3.83±1.65比4.72±2.25，BUN（mmol/L）：7.1±2.7比9.3±3.5，Cr（μmol/L）：73.9±16.2比95.7±15.8，AST（U/L）：39.8±9.5比45.8±12.7，ALT（U/L）：34.3±9.7比41.7±11.3，均P＜0.05〕。疏血通组各种血管活性药物的总用量均明显少于常规治疗组〔多巴胺（mg）：993.1±261.7比1340.9±356.4，多巴酚丁胺（mg）：776.2±281.0比1049.2±364.3，去甲肾上腺素（mg）：56.4±34.6比107.6±51.3，均P＜0.05〕；疏血通组28 d病死率明显低于常规治疗组〔40.0%（16/40）比60.0%（24/40），P＜0.05〕。结论疏血通注射液可以改善脓毒性休克患者的微循环灌注，降低患者病死率。
목적：분석소혈통주사액대농독성휴극환자미순배적영향급치료효과。방법채용전첨성연구방법。장하북성중의원중증의학과수치적80례농독성휴극환자안수궤수자표법분위소혈통조화상규치료조，매조40례。량조환자균안조농독성휴극지남추천적방법진행적겁적액체복소화항감염등상규치료；소혈통조재상규치료기출상급여소혈통주사액6 mL가5%포도당주사액250 mL정맥적주（정적），매일1차，공용7 d。관찰량조환자치료전후적뇨량、유산（Lac）、뇨소담（BUN）、기항（Cr）、천동안산전안매（AST）、병안산전안매（ALT）、좌실사혈분수（LVEF）、심배혈지수（CI）。기록량조다파알、다파분정알、거갑신상선소등혈관활성약물적총용량화28 d병사솔。결과량조치료전뇨량、Lac、BUN、Cr、AST、ALT、LVEF、CI수평비교차이균무통계학의의（균P＞0.05）；량조치료후뇨량、LVEF、CI균교치료전증가，Lac、BUN、Cr、AST、ALT균교치료전명현강저，차이소혈통조변화경현저〔뇨량（mL/h）：112.1±39.8비73.3±28.5，LVEF：0.49±0.15비0.44±0.14，CI（mL·s-1·m-2）：66.2±5.7비54.2±6.2，Lac（mmol/L）：3.83±1.65비4.72±2.25，BUN（mmol/L）：7.1±2.7비9.3±3.5，Cr（μmol/L）：73.9±16.2비95.7±15.8，AST（U/L）：39.8±9.5비45.8±12.7，ALT（U/L）：34.3±9.7비41.7±11.3，균P＜0.05〕。소혈통조각충혈관활성약물적총용량균명현소우상규치료조〔다파알（mg）：993.1±261.7비1340.9±356.4，다파분정알（mg）：776.2±281.0비1049.2±364.3，거갑신상선소（mg）：56.4±34.6비107.6±51.3，균P＜0.05〕；소혈통조28 d병사솔명현저우상규치료조〔40.0%（16/40）비60.0%（24/40），P＜0.05〕。결론소혈통주사액가이개선농독성휴극환자적미순배관주，강저환자병사솔。
Objective To analyze the effect of Shuxuetong injection on microcirculation in patients with septic shock and its therapeutic effect. Methods A prospective study was conducted. Eighty patients with septic shock treated in Department of Critical Care Medicine of Hebei Provincial Traditional Chinese Medical Hospital were randomly divided into a Shuxuetong group and a conventional therapy group according to random number table, 40 cases in each group. The conventional treatment in the two groups was energetically carried out in accord to the sepsis shock guidelines, such as positive fluid resuscitation, anti-infection, etc. In the Shuxuetong group, additionally Shuxuetong injection 6 mL in 5% glucose injection 250 mL intravenous drip was given once a day for 7 days. The levels of urine output, lactic acid (Lac), blood urea nitrogen (BUN), creatinine (Cr), aspartate aminotransferase (AST), alanine aminotransferase (ALT), left ventricular ejection fraction (LVEF), and cardiac index (CI) in the two groups were observed before and after treatment; the total dosages of dopamine, dobutamine, noradrenaline, etc. vascoactive agent used for the patients and 28-day mortality in the two groups were also recorded. Results The comparisons of levels of urine output, Lac, BUN, Cr, AST, ALT, LVEF, and CI before treatment between the two groups were of no statistical significant differences (all P>0.05). After treatment in the two groups, the urine output, LVEF, and CI were increased compared with those before treatment, whereas the Lac, BUN, Cr, AST, and ALT were significantly decreased, and the changes were more obvious in Shuxuetong group [urine output (mL/h):112.1±39.8 vs. 73.3±28.5, LVEF:0.49±0.15 vs. 0.44±0.14, CI (mL·s-1·m-2):66.2±5.7 vs. 54.2±6.2, Lac (mmol/L):3.83±1.65 vs. 4.72±2.25, BUN (mmol/L):7.1±2.7 vs. 9.3±3.5, Cr (μmol/L): 73.9±16.2 vs. 95.7±15.8, AST (U/L): 39.8±9.5 vs. 45.8±12.7, ALT (U/L):34.3±9.7 vs. 41.7±11.3, all P<0.05]. The total dosages of all kinds of vascoactive agent of Shuxuetong group were remarkably less than those in the conventional therapy group [dopamine (mg): 993.1±261.7 vs. 1 340.9±356.4, dobutamine (mg):776.2±281.0 vs. 1 049.2±364.3, noradrenaline (mg):56.4±34.6 vs. 107.6±51.3, all P<0.05]. The 28-day mortality of Shuxuetong group was obviously lower than that of conventional therapy group [40.0%(16/40) vs. 60.0%(24/40), P<0.05]. Conclusion Shuxuetong injection can improve the microcirculation perfusion in patients with septic shock and reduce their mortality.