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摘要: 目的 观察代谢复苏疗法对于脓毒性休克患者的治疗效果。方法 纳入138例脓毒性休克患者为研究对象，随机分为对照组(69例)和试验组(69例)。对照组给予常规治疗，试验组在常规治疗的基础上联合给予氢化可的松+维生素C+维生素B1注射液。在治疗前和治疗后24、48 h检测血流动力学参数[平均动脉压(MAP)、中心静脉压(CVP)]。同时比较两组炎性因子的水平，随访预后。结果 治疗48 h后，试验组的中心静脉血氧饱和度(ScvO2)高于对照组，Lac、PCT、IL-6、TNF-α、APACHEⅡ评分以及SOFA评分显著低于对照组，差异有统计学意义。试验组的ICU治疗时间、总住院时间、血管活性药物应用时间、机械通气时间以及CRRT应用时间均显著低于对照组，差异有统计学意义。结论 代谢复苏疗法能够改善脓毒性休克患者的氧化应激反应，清除炎症，预防器官功能障碍，并且能够减少血管活性药物的使用时间。Abstract: Objective To observe the effect of metabolic resuscitation on patients with septic shock.Methods One hundred and thirty-eight patients with septic shock were included, they were randomly divided into control group(69 cases) and experimental group(69 cases). The control group was given routine treatment, and the research group was given hydrocortisone + vitamin C+ vitamin B1 injection on the basis of routine treatment. Hemodynamic parameters(mean arterial pressure, MAP) and central venous pressure(CVP)were measured before, 24 and 48 h after treatment. Meanwhile, the levels of inflammatory factors in the two groups were compared and the prognosis was followed-up.Results After 48 hours of treatment, ScvO2 in the experimental group was higher than that in the control group, while Lac, PCT, IL-6, TNF-α, APACHEⅡ and SOFA were lower than those in the control group, with statistically significant differences. The ICU-stay time, total hospital-stay time, the duration of vasoactive, mechanical ventilation and CRRT of the experimental group were lower than those of the control group, and the difference was statistically significant.Conclusion Metabolic resuscitation therapy can improve the Oxidative stress of patients with septic shock and clear inflammation, prevent organ dysfunction, and reduce the duration of vasoactive drugs.
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Key words:
- septic shock /
- prognosis /
- metabolic resuscitation
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表 1 两组患者血流动力学参数以及组织灌注指标的比较
组别 HR/(次·min-1) MAP/mmHg CVP/mmHg 去甲肾上腺素用量/(μg·kg-1·min-1) ScvO2/% pH BE/(mmol·L-1) Lac/(mmol·L-1) 对照组 治疗前 86.17±18.88 76.22±6.03 8.42±3.44 0.74±0.51 61.28±7.14 7.36±0.1 -4.04±5.17 4.65±3.87 治疗后24 h 84.59±18.08 82.52±6.591) 7.81±3.29 0.59±0.431) 64.38±6.49 1) 7.37±0.1 -3.46±4.73 3.41±2.081) 治疗后48 h 85.13±18.91 84.49±6.291) 8.17±3.63 0.51±0.431) 65.33±6.80 1) 7.38±0.1 -3.66±4.85 2.09±1.541) 试验组 治疗前 89.39±17.68 78.06±9.26 8.43±3.85 0.72±0.5 61.41±6.61 7.34±0.1 -3.68±6.23 4.56±3.76 治疗后24 h 88.03±17.17 82.03±8.861) 7.31±3.67 0.54±0.311) 63.78±6.56 1) 7.35±0.1 -2.74±5.70 2.71±1.691) 治疗后48 h 86.78±16.79 87.51±5.841)2) 6.49±3.77 1)2) 0.45±0.321) 67.88±6.56 1)2) 7.37±0.1 -2.32±5.90 1.21±0.991)2) 与治疗前比较，1)P < 0.05；与同一时间点对照组相比，2)P < 0.05。 
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表 2 两组患者治疗前后炎性因子比较
组别 CRP/(mg·L-1) WBC/(109·L-1) N/% PCT/(ng·mL-1) IL-6/(pg·mL-1) TNF-α/(pg·mL-1) 对照组 治疗前 151.43±139.64 16.25±11.41 15.16±15.34 22.96±31.59 26.22±12.13 26.37±10.98 治疗后24 h 108.67±108.171) 14.82±10.82 14.74±15.27 13.30±20.261) 22.21±9.071) 22.72±10.21) 治疗后48 h 105.91±121.081) 13.79±9.68 11.24±15.27 12.99±18.611) 22.00±11.471) 22.34±10.631) 试验组 治疗前 161.18±138.75 13.42±8.95 12.63±9.74 18.90±30.15 25.96±12.53 25.87±10.91 治疗后24 h 118.85±112.711) 12.7±8.86 10.95±8.42 11.95±21.371) 20.55±12.161) 20.28±11.261) 治疗后48 h 108.87±103.891) 11.74±8.89 11.01±8.32 5.21±6.581)2) 17.88±11.91)2) 18.15±10.821)2) 与治疗前比较，1)P < 0.05；与同一时间点对照组相比，2)P < 0.05。
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表 3 两组患者预后因素分析
组别 ICU治疗时间/d 总住院时间/d 血管活性药物时间/d 机械通气时间/d CRRT时间/d 28 d病死率/% 对照组 16.93±3.81 19.83±4.01 12.90±3.62 12.49±4.37 10.84±4.08 50.7 试验组 14.37±3.381) 18.40±4.091) 11.47±3.021) 10.26±2.921) 8.47±3.791) 49.3 与治疗前比较，1)P < 0.05；与同一时间点对照组相比，2)P < 0.05。
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表 4 两组患者治疗评分比较
组别 APACHEⅡ评分/分 SOFA评分/分 对照组 治疗前 22.16±10.09 12.68±5.41 治疗后24 h 18.87±9.341) 10.06±4.851) 治疗后48 h 17.26±8.71) 8.83±4.391) 试验组 治疗前 21.93±10.13 12.80±5.69 治疗后24 h 16.70±7.551) 10.88±5.481) 治疗后48 h 14.07±8.821)2) 7.07±3.931)2) 与同组治疗前比较，1)P < 0.05；与同一时间点对照组比较，2)P < 0.05。
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[1] 黄昆鹏, 张进祥. 脓毒症的定义、诊断与早期干预——不可分割的三要素[J]. 临床急诊杂志, 2021, 22(3): 221-226. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202103016.htm
[2] 吴淼, 杜贤进, 魏捷, 等. 华中地区79家医院急诊脓毒症诊治现状调查分析[J]. 临床急诊杂志, 2021, 22(4): 291-296. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202104016.htm
[3] Rudd KE, Johnson SC. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study[J]. Lancet, 2020, 395(10219): 200-211. doi: 10.1016/S0140-6736(19)32989-7
[4] Zhang X, Yang K, Chen L, et al. Vitamin A deficiency in critically ill children with sepsis[J]. Crit Care, 2019, 23(1): 267. doi: 10.1186/s13054-019-2548-9
[5] Parikh R, Belok SH, Swamy L, et al. Adjunctive Therapies in the Management of Septic Shock[J]. Am J Respir Crit Care Med, 2019, 200(3): 381-383. doi: 10.1164/rccm.201810-1991RR
[6] Vail EA, Wunsch H, Pinto R, et al. Use of Hydrocortisone, Ascorbic Acid, and Thiamine in Adults with Septic Shock[J]. Am J Respir Crit Care Med, 2020, 202(11): 1531-1539. doi: 10.1164/rccm.202005-1829OC
[7] Wald EL, Sanchez-Pinto LN, Smith CM, et al. Hydrocortisone-Ascorbic Acid-Thiamine Use Associated with Lower Mortality in Pediatric Septic Shock[J]. Am J Respir Crit Care Med, 2020, 201(7): 863-867. doi: 10.1164/rccm.201908-1543LE
[8] 马丁, 周荣. 脓毒症内皮细胞损伤相关生物标志物的研究进展[J]. 临床急诊杂志, 2021, 22(1): 72-76. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202101017.htm
[9] 王世伟, 吕丹, 龚好, 等. 参附联合维生素C对脓毒性休克患者血管内皮损伤的保护作用研究[J]. 临床急诊杂志, 2021, 22(10): 641-646. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202110001.htm
[10] Hofmaenner DA, Kleyman A, Press A, et al. The Many Roles of Cholesterol in Sepsis: A Review[J]. Am J Respir Crit Care Med, 2022, 205(4): 388-396. doi: 10.1164/rccm.202105-1197TR
[11] Mohamed ZU, Prasannan P, Moni M, et al. Vitamin C Therapy for Routine Care in Septic Shock(ViCTOR)Trial: Effect of Intravenous Vitamin C, Thiamine, and Hydrocortisone Administration on Inpatient Mortality among Patients with Septic Shock[J]. Indian J Crit Care Med, 2020, 24(8): 653-661. doi: 10.5005/jp-journals-10071-23517
[12] Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids in the treatment of severe sepsis and septic shock in adults: a systematic review[J]. JAMA, 2009, 301(20): 2362-2375.
[13] Li R, Guo C, Li Y, et al. Therapeutic targets and signaling mechanisms of vitamin C activity against sepsis: a bioinformatics study[J]. Brief Bioinform, 2021, 22(3): 79.
[14] Sevransky JE, Rothman RE, Hager DN, et al. Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator-and Vasopressor-Free Days in Patients With Sepsis: The VICTAS Randomized Clinical Trial[J]. JAMA, 2021, 325(8): 742-750.
[15] Wang Y, Lin H, Lin BW, et al. Effects of different ascorbic acid doses on the mortality of critically ill patients: a meta-analysis[J]. Ann Intensive Care, 2019, 9(1): 58. doi: 10.1186/s13613-019-0532-9
[16] Iglesias J, Vassallo AV, Patel VV, et al. Outcomes of Metabolic Resuscitation Using Ascorbic Acid, Thiamine, and Glucocorticoids in the Early Treatment of Sepsis: The ORANGES Trial[J]. Chest, 2020, 158(1): 164-173.
[17] Moskowitz A, Huang DT, Hou PC, et al. Effect of Ascorbic Acid, Corticosteroids, and Thiamine on Organ Injury in Septic Shock: The ACTS Randomized Clinical Trial[J]. JAMA, 2020, 324(7): 642-650.
[18] Lankadeva YR, Peiris RM, Okazaki N, et al. Reversal of the Pathophysiological Responses to Gram-Negative Sepsis by Megadose Vitamin C[J]. Crit Care Med, 2021, 49(2): e179-e190.
[19] Garg P, Tirlangi P, Arora U, et al. Vitamin C in Sepsis: The Road Ahead[J]. Chest, 2021, 159(2): 879-880. https://pubmed.ncbi.nlm.nih.gov/33563440/
[20] Chang P, Liao Y, Guan J, et al. Combined Treatment With Hydrocortisone, Vitamin C, and Thiamine for Sepsis and Septic Shock: A Randomized Controlled Trial[J]. Chest, 2020, 158(1): 174-182.
[21] Honore PM, Redant S, Djimafo P, et al. Wacker et al, Who Conclude That Vitamin C Monotherapy Failed to Significantly Reduce Mortality in Septic Shock Patients: Beware of Potential Confounding Factors![J]. Crit Care Med, 2022, 50(6): e611-e612.
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| 引用本文: |
王丽晖, 姬骁亮, 刘文悦. 代谢复苏疗法在脓毒性休克患者中的临床意义[J]. 临床急诊杂志, 2022, 23(8): 587-591. doi: 10.13201/j.issn.1009-5918.2022.08.009
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| Citation: |
WANG Lihui, JI Xiaoliang, LIU Wenyue. Significance of metabolic resuscitation therapy in patients with septic shock[J]. J Clin Emerg, 2022, 23(8): 587-591. doi: 10.13201/j.issn.1009-5918.2022.08.009
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