Efficiency observation of blood purification therapy combined with Shenfu Injection in treatment of patients with septic shock
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摘要:目的 探讨脓毒性休克患者应用血液净化联合参附注射液治疗的效果。方法 将68例脓毒性休克患者随机分为联合组与常规组，每组34例。常规组患者采用血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)的血液净化方案，联合组在常规组基础上加用参附注射液治疗。比较2组患者不同治疗时间点的炎性细胞因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、C反应蛋白(CRP)、降钙素原(PCT)]水平、生命体征指标[急性生理与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、平均动脉压(MAP)、血乳酸(Lac)、氧合指数(OI)], 以及生存与死亡患者血清炎性细胞因子水平。结果 第1、2、3次治疗后, 2组患者炎性细胞因子水平均较同组治疗前显著降低，且联合组降低水平显著大于常规组(P < 0.05)。第1、2、3次治疗后, 2组患者APACHE Ⅱ评分、Lac水平均较同组治疗前显著降低, MAP、OI水平较治疗前显著升高，且联合组APACHE Ⅱ评分、Lac降低水平以及MAP、OI升高水平显著大于常规组(P < 0.05)。联合组患者28 d存活率为67.65%, 常规组为58.82%, 差异无统计学意义(P>0.05)。联合组中存活患者的TNF-α、IL-10、CRP、PCT水平显著低于常规组中存活患者(P < 0.05)。2组中死亡患者的上述指标水平比较无显著差异(P > 0.05)。结论 参附注射液联合HP及CVVH能有效降低脓毒性休克患者体内的炎性细胞因子水平，增加组织循环血量，降低Lac水平，改善患者预后，提高患者存活率。
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关键词:
- 脓毒性休克 /
- 血液净化 /
- 血液灌注 /
- 连续性静脉-静脉血液滤过 /
- 血乳酸 /
- 炎性细胞因子 /
- 参附注射液 /
- 急性生理与慢性健康状况评分系统Ⅱ
Abstract:Objective To investigate the effect of blood purification combined with Shenfu Injection in the treatment of septic shock.Methods Totally 68 patients with septic shock were randomly divided into combined group and routine group, with 34 cases in each group. The routine group was treated by blood perfusion (HP) combined with continuous veno-venous hemofiltration (CVVH), and the combined group was treated with Shenfu Injection on the basis of routine group. The levels of inflammatory cytokines [tumor necrosis factor-α (TNF-α), interleukin-10 (IL-10), C reactive protein (CRP), procalcitonin (PCT)] and vital signs [Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), mean arterial pressure (MAP), blood lactic acid (Lac), oxygenation index (OI)] at different time points were compared between two groups, and levels of serum inflammatory cytokines were compared between survival and death patients.Results After the first, second and third treatments, the levels of inflammatory cytokines in both groups were significantly lower than those before treatment, and the levels of inflammatory cytokines in the combined group were significantly lower than those in the routine group (P < 0.05). After the first, second and third treatments, the APACHE Ⅱ scores and Lac levels in both groups were significantly lower than those before treatment, the levels of MAP and OI were significantly higher than those before treatment, and APACHE Ⅱ scores, Lac levels and the levels of MAP and OI in the combined group were significantly better than those in the routine group (P < 0.05). The 28-day survival rate was 67.65% in the combined group and 58.82% in the routine group, which showed no significant difference (P>0.05). The levels of TNF-α, IL-10, CRP and PCT of survival patients in the combined group were significantly lower than those of survival patients in the routine group (P < 0.05). There were no significant differences in the above indexes in the died patients between the two groups (P > 0.05).Conclusion Shenfu Injection combined with HP and CVVH can effectively reduce the levels of inflammatory cytokines in patients with septic shock, increase circulation blood volume of tissue, reduce the level of Lac, improve the prognosis of patients, and improve the survival rate of patients. -
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表 1 2组患者一般资料比较(x±s)
组别 n 性别 年龄/岁 APACHE Ⅱ评分/分 感染部位 男 女 腹腔 泌尿系统 肝胆 其他 联合组 34 20 14 48.32±8.76 26.63±3.78 24 6 3 1 常规组 34 18 16 49.12±9.16 26.10±3.91 22 7 4 1 APACHE Ⅱ: 急性生理与慢性健康状况评分系统Ⅱ。 
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表 2 联合组与常规组患者不同时点的血清炎性细胞因子水平比较(x±s)
时点 组别 TNF-α/(pg/mL) IL-10/(pg/mL) CRP/(mg/L) PCT/(ng/mL) 治疗前 联合组 358.14±108.34 108.13±35.37 211.41±39.93 88.57±7.45 常规组 358.63±110.27 106.10±35.61 212.65±40.43 88.34±8.12 第1次治疗后 联合组 314.71±93.23*# 97.71±30.12*# 176.35±35.81*# 67.19±7.10*# 常规组 320.43±108.41* 101.91±33.51* 189.34±42.12* 75.35±8.02* 第2次治疗后 联合组 264.73±90.15*# 87.41±27.34*# 98.12±31.41*# 39.42±5.63*# 常规组 303.34±102.31* 95.51±30.17* 131.91±34.47* 48.27±7.31* 第3次治疗后 联合组 223.30±81.27*# 76.63±24.60*# 53.41±25.49*# 18.63±4.52*# 常规组 267.01±86.31* 89.81±28.36* 77.91±30.72* 28.33±6.67* TNF-α: 肿瘤坏死因子-α; IL-10: 白细胞介素-10; CRP: C反应蛋白; PCT: 降钙素原。与治疗前比较, *P < 0.05; 与常规组比较, #P < 0.05。
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表 3 联合组与常规组患者不同时点的生命体征指标比较(x±s)
时点 组别 APACHE Ⅱ评分/分 MAP/mmHg Lac/(mmol/L) OI/mmHg 治疗前 联合组 26.63±3.78 65.37±5.43 4.81±1.71 165.31±48.13 常规组 26.10±3.91 65.49±4.38 4.89±1.76 164.91±48.70 第1次治疗后 联合组 22.87±2.11*# 74.91±7.01*# 4.34±1.53*# 232.21±43.56*# 常规组 24.42±3.17* 69.67±6.38* 4.68±1.65* 192.76±44.21* 第2次治疗后 联合组 17.30±1.62*# 81.83±7.32*# 3.42±1.44*# 267.18±41.32*# 常规组 20.78±2.63* 74.43±6.81* 4.25±1.48* 237.55±42.16* 第3次治疗后 联合组 12.03±1.18*# 86.90±7.41*# 2.58±1.39*# 315.80±34.31*# 常规组 18.33±1.89* 78.56±7.12* 3.51±1.30* 275.57±38.68* APACHE Ⅱ: 急性生理与慢性健康评分; MAP: 平均动脉压; Lac: 血乳酸; OI: 氧合指数。*P < 0.05; 与常规组比较, #P < 0.05。
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表 4 2组中存活与死亡患者血清炎性细胞因子水平比较(x±s)
组别 状态 TNF-α/(pg/mL) IL-10/(pg/mL) CRP/(mg/L) PCT/(ng/mL) 联合组(n=34) 存活(n=23) 189.53±71.31* 56.33±22.61* 42.45±19.34* 15.35±3.78* 死亡(n=11) 363.24±112.33 102.43±37.42 203.65±35.13 81.37±6.31 常规组(n=34) 存活(n=20) 241.03±78.35 67.46±23.41 69.32±24.21 33.58±4.62 死亡(n=14) 368.53±115.14 102.81±38.47 204.68±35.20 83.11±6.63 TNF-α: 肿瘤坏死因子-α; IL-10: 白细胞介素-10; CRP: C反应蛋白; PCT: 降钙素原。与常规组存活者比较, *P < 0.05。
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