-
摘要: 目的 探讨参附注射液对脓毒性休克患者凝血功能、舌下微循环及其预后的影响。方法 收集2022年1月1日—2023年6月30日上海市浦东新区人民医院重症医学科符合脓毒性休克的患者150例，记录患者的年龄、性别，入科当天及第7天的初始血乳酸、白细胞计数、血小板计数、C反应蛋白、血红蛋白、白蛋白、凝血功能及舌下微循环参数等实验室检查指标以及SOFA评分、APACHEⅡ评分及90 d生存状态。将患者随机分为实验组(75例)与对照组(75例)。比较两组患者在凝血功能和舌下微循环改善及预后方面的差异。结果 治疗后两组患者的凝血功能指标较前有所好转，两组之间差异有统计学意义(P＜0.05)。治疗后舌下微循环参数实验组中改善的更明显，两组之间差异有统计学意义(P＜0.05)。使用Kaplan-Meier生存分析发现，与对照组比较，实验组患者90 d生存率较高(78.7% vs. 70.7%)，但两组之间差异无统计学意义(P=0.26)。结论 参附注射液能改善脓毒性休克患者的凝血功能及舌下微循环状态，对改善预后亦有一定价值。Abstract: Objective To explore the effect of Shenfu injection on coagulation function, sublingual microcirculation and prognosis of septic shock patients.Methods One hundred and fifty patients with septic shock were collected from the Department of Critical Care Medicine of Shanghai Pudong New Area People's Hospital from January 1, 2022 to June 30, 2023. The age and sex of the patients, the initial blood lactic acid, white blood cell count, platelet count, C-reactive protein, hemoglobin, albumin, coagulation function and sublingual microcirculation parameters on the first and seventh day of admission, and the sequential organ failure assessment score, acute physiology and chronic health evaluationⅡscore and 90-day survival status were recorded. Patients were randomly divided into experimental group(75 cases) and control group(75 cases). The differences of coagulation function, sublingual microcirculation improvement and prognosis between the two groups were compared.Results After treatment, the indexes of coagulation function in the two groups were better than before, and the difference between the two groups was statistically significant(P<0.05). The parameters of sublingual microcirculation were improved after treatment, especially in the experimental group, and the difference between the two groups was statistically significant(P<0.05). Kaplan-Meier survival analysis showed that the 90-day survival rate of patients in the experimental group was higher(experimental group vs. control group: 78.7% vs. 70.7%), but there was no significant difference between the two groups(P=0.26).Conclusion Shenfu injection can improve the coagulation function and sublingual microcirculation of septic shock patients, and has certain value in improving prognosis.
-
Key words:
- septic shock /
- shenfu injection /
- coagulation function /
- sublingual microcirculation /
- prognosis
-
-
表 1 实验组与对照组一般基线资料比较
X±S，M(P25，P75) 一般资料 实验组(75例) 对照组(75例) t/Z P 年龄/岁 72.05±13.02 67.79±14.94 1.865 0.064 性别/例 1.714 0.190 男 36 44 女 39 31 白细胞计数/(×109/L) 13.27(10.87，17.99) 13.53(11.50，19.47) -0.412 0.681 血小板计数/(×109/L) 173.19±78.83 152.08±87.44 1.553 0.123 C-反应蛋白/(mg/L) 91.21±62.31 112.78±83.99 -1.780 0.077 血红蛋白/(×109/L) 110.79±16.68 108.84±16.54 0.781 0.474 白蛋白/(g/L) 30.50±3.37 30.37±3.60 0.232 0.817 乳酸/(mmol/L) 5.10(4.50，6.70) 5.80(4.70，7.60) -1.531 0.126 SOFA评分/分 7.84±2.52 8.05±2.69 -0.502 0.617 APACHEⅡ评分/分 22.51±9.34 22.80±9.01 -0.196 0.845 
下载: 导出CSV
表 2 治疗前后凝血指标比较
X±S，M(P25，P75) 项目 治疗前 治疗后 实验组(75例) 对照组(75例) P 实验组(75例) 对照组(75例) P PT/s 14.83±2.19 15.58±3.22 0.098 14.03±2.07 14.98±3.16 0.031 APTT/s 38.32±9.76 40.34±11.26 0.243 35.13±5.68 37.37±7.43 0.040 INR 1.17±0.21 1.23±0.41 0.239 1.08±0.15 1.17±0.32 0.036 FIB/(g/L) 4.45±1.61 4.41±1.64 0.894 3.83±1.44 4.40±1.71 0.030 D-D/(mg/L) 5.71(2.65，13.80) 8.68(3.50，13.90) 0.237 5.32(2.65，8.94) 8.62(3.50，11.70) 0.048
下载: 导出CSV
表 3 治疗前后舌下微循环指标的比较
X±S 项目 治疗前 治疗后 实验组(75例) 对照组(75例) P 实验组(75例) 对照组(75例) P MFI 2.43±0.57 2.51±0.56 0.404 2.89±0.58 2.70±0.56 0.046 PPV/% 84.45±4.81 85.00±4.57 0.470 89.13±4.41 87.32±4.69 0.017 TVD/(mm/mm2) 9.38±2.29 9.58±2.15 0.579 11.17±2.37 10.32±2.24 0.025 PVD/(mm/mm2) 8.75±2.15 8.60±1.92 0.652 10.02±2.21 9.27±2.08 0.034
下载: 导出CSV
-
[1] 张涛, 万亚楠, 王逸平, 等. 脓毒症患者DIC预警系统构建与临床研究[J]. 临床急诊杂志, 2021, 22(8): 513-520. https://lcjz.whuhzzs.com/article/doi/10.13201/j.issn.1009-5918.2021.08.001
[2] Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021[J]. Crit Care Med, 2021, 49(11): e1063-e1143. doi: 10.1097/CCM.0000000000005337
[3] Iba T, Levy JH. Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation[J]. Anesthesiology, 2020, 132(5): 1238-1245. doi: 10.1097/ALN.0000000000003122
[4] Delabranche X, Helms J, Meziani F. Immunohaemostasis: a new view on haemostasis during sepsis[J]. Ann Intensive Care, 2017, 7(1): 117. doi: 10.1186/s13613-017-0339-5
[5] Munroe ES, Hyzy RC, Semler MW, et al. Evolving Management Practices for Early Sepsis-induced Hypoperfusion: A Narrative Review[J]. Am J Respir Crit Care Med, 2023, 207(10): 1283-1299. doi: 10.1164/rccm.202209-1831CI
[6] 蒋国平, 雷李美, 文怀, 等. 参附注射液对多发创伤并发休克患者凝血功能的影响[J]. 中华急诊医学杂志, 2012, 21(10): 1127-1129. doi: 10.3760/cma.j.issn.1671-0282.2012.10.015
[7] Hong F, He C, Liu X, et al. Protective effect of Shenfu injection on thromboangiitis obliterans model rats[J]. J Ethnopharmacol, 2011, 138(2): 458-462. doi: 10.1016/j.jep.2011.09.033
[8] Wu Y, Xia ZY, Meng QT, et al. Shen-Fu injection preconditioning inhibits myocardial ischemia-reperfusion injury in diabetic rats: activation ofeNos via the PI3K/Akt pathway[J]. J Biomed Biotechnol, 2011, 384627: 1-9.
[9] Ji X F, Yang L, Zhang M Y, et al. Shen-fu injection attenuates postresus citation myocardial dysfunction in a porcine model of cardiac arrest[J]. Shock, 2011, 35(5): 530-536. doi: 10.1097/SHK.0b013e31820e2058
[10] Suh GJ, Shin TG, Kwon WY, et al. Hemodynamic management of septic shock: beyond the Surviving Sepsis Campaign guidelines[J]. Clin Exp Emerg Med, 2023, 10(3): 255-264. doi: 10.15441/ceem.23.065
[11] Iba T, Levy JH. Sepsis-induced Coagulopathy and Disseminated Intravascular Coagulation[J]. Anesthesiology, 2020, 132(5): 1238-1245. doi: 10.1097/ALN.0000000000003122
[12] Rudd KE, Johnson SC, Agesa KM, et al. 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
[13] Prescott HC, Angus DC. Enhancing Recovery From Sepsis: A Review[J]. JAMA, 2018, 319(1): 62-75. doi: 10.1001/jama.2017.17687
[14] Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016[J]. Crit Care Med, 2017, 45(3): 486-552.
[15] Sweeney S, Mukora R, Candfield S, et al. Measuring income for catastrophic cost estimates: Limitations and policy implications of current approaches[J]. Soc Sci Med, 2018, 215: 7-15. doi: 10.1016/j.socscimed.2018.08.041
[16] 张涛, 万亚楠, 卢昕媛, 等. 血栓弹力图对脓毒症患者弥散性血管内凝血的诊断价值及预后的影响[J]. 临床急诊杂志, 2022, 23(7): 6. https://lcjz.whuhzzs.com/article/doi/10.13201/j.issn.1009-5918.2022.07.004
[17] Mayeux PR, MacMillan-Crow LA. Pharmacological targets in the renal peritubular microenvironment: implications for therapy for sepsis-induced acute kidney injury[J]. Pharmacol Ther, 2012, 134(2): 139-155. doi: 10.1016/j.pharmthera.2012.01.004
[18] Christopher W, Seymou R, Vincent X, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock(sepsis-3)[J]. JAMA, 2016, 315(8): 762-774. doi: 10.1001/jama.2016.0288
[19] Guo F, Zhu X, Wu Z, et al. Clinical applications of machine learning in the survival prediction and classification of sepsis: coagulation and heparin usage matter[J]. J Transl Med, 2022, 20(1): 265. doi: 10.1186/s12967-022-03469-6
[20] Lin CH, Wang YH, Chen YW, et al. Transcriptional and posttranscriptional regulation of CXCL8/IL-8 gene expression induced by connective tissue growth factor[J]. Immunol Res, 2016, 64(2): 369-384. doi: 10.1007/s12026-015-8670-0
[21] Xing X, Jiang R, Wang L, et al. Shenfu injection alleviates intestine epithelial damage in septic rats[J]. Am J Emerg Med, 2015, 33(11): 1665-1670. doi: 10.1016/j.ajem.2015.08.001
[22] 丁文博, 王飞. 脓毒症大鼠肝损伤机制及参附注射液治疗作用研究[J]. 亚太传统医药, 2012, 8(4): 6-9.
[23] 贾合磊, 卢长青, 王娟, 等. 参附注射液通过调控自噬减轻大鼠心肌缺血再灌注损伤的作用研究[J]. 中国免疫学杂志, 2019, 35(18): 2213-2220.
[24] 张艺红, 刘智. 人参皂苷Rg1对冠心病大鼠的影响研究[J]. 中国临床药理学杂志, 2020, 36(2): 133-136.
[25] Zhu J, Song W, Xu S, et al. Shenfu Injection Promotes Vasodilation by Enhancing eNOS Activity Through the PI3K/Akt Signaling Pathway In Vitro[J]. Front Pharmacol, 2020, 11: 121.
[26] 杨斌, 牛京京, 张慧峰, 等. 小剂量氢化可的松联合参附注射液治疗感染性休克的临床疗效[J]. 中国中西医结合急救杂志, 2021, 28(1): 52-54.
[27] Zhang MY, Ji XF, Wang S, et al. Shen-Fu injection attenuates postresuscitation lung injury in a porcine model of cardiac arrest[J]. Resuscitation, 2012, 83(9): 1152-1158.
[28] Senftle ben U, Karin M. The IKK/NF-kB path way[J]. Care Med, 2002, 30(1 Suppl): S18-S26.
[29] Zingarelli B, Sheehan M, Wong HR. Nuclear factor-kB as atherapeutic target in critical care medicine[J]. Crit Care Med, 2003, 31(1Suppl): S105-S111.
-
图(3)
表(3)
计量
- 文章访问数: 586
- PDF下载数: 103
- 施引文献: 0