早期持续血液净化联合醒脑静治疗重症中暑临床研究
|
摘要
目的:评价早期持续血液净化(CBP)联合醒脑静治疗重症中暑的临床效果。方法:选取ICU住院的重症中暑患者29例,按随机数字表法分为治疗组14例和对照组15例。对照组给予常规治疗,治疗组在对照组基础上加用CBP联合醒脑静注射液治疗。观察2组入院体温、体温降至38.5℃时间、体温至正常的时间、功能障碍器官数及住院时间。比较治疗7天后,2组格拉斯哥昏迷指数(GCS),心率(HR)及平均动脉压(MAP),氧合指数(PO_2/FiO_2),血乳酸(Lac)以及APECHEⅡ评分的变化。统计住院天数、病死率、致残率。结果:治疗后,治疗组体温降至38.5℃时间、体温降至正常时间及住院时间明显短于对照组,差异有统计学意义(P <0.05)。治疗前,2组APECHEⅡ评分、GCS评分、HR、MAP、PO_2/FiO_2、Lac比较,差异均无统计学意义(P> 0.05)。治疗后,2组APECHEⅡ评分、HR、Lac较治疗前降低,GCS评分、MAP、PO_2/FiO_2较治疗前升高;且治疗组APECHEⅡ评分、HR、Lac低于对照组,GCS评分、MAP、PO_2/FiO_2高于对照组;差异均有统计学意义(P <0.05)。2组病死率、致残率比较,差异无统计学意义(P> 0.05)。结论:早期持续血液净化联合醒脑静治疗重症中暑可以迅速降低机体核心体温,稳定血压,改善患者意识障碍,改善肺部氧合及全身灌注,疗效显著。
Objective:To evaluate the clinical effect of early contiuous blood purification(CBP) combined with Xingnaojing injection for severe heat stroke. Methods:Selected 29 cases of patients with severe heat stroke who were admitted in ICU,and divided them into two groups randomly,14 cases in the treatment group and 15 cases in the control group. The control group received routine treatment,while the treatment group additionally received CBP combined with Xingnaojing injection.Observed the body temperature at admission,the time of body temperature deceasing to 38.5 ℃,the time of body temperature back to norm, the number of dysfunctional organs and hospitalization time in both groups; after 7 days of treatment,compared the changes in scores of Glasgow coma scale(GCS),heart rate(HR),mean arterial pressure(MAP),oxygenation index(PO_2/FiO 2),blood lactic acid(Lac) and APECHE II scores in both groups;statistically analyzed the hospitalization days,mortality rate and disability rate. Results:After treatment,the time of body temperature deceasing to 38.5 ℃,the time of body temperature back to norm and hospitalization time in the treatment group were significantly shorter than those in the control group,difference being significant(P < 0.05). Before treatment,comparing the scores of APECHE II and GCS,HR,MAP,PO_2/Fi O_2 and Lac,there were no significant differences being found(P > 0.05). After treatment,the scores of APECHE II,HR and Lac in both groups were lower than those before treatment,and the scores of GCS,MAP and PO_2/Fi O_2 were higher than those before treatment;the scores of APECHE II,HR and Lac in the treatment group were lower than those in the control group, and the scores of GCS, MAP and PO_2/FiO 2 were higher than in the control group, differences being significant(P < 0.05). Comparing the mortality rate and the disability rate in both groups,there was no significant difference being found(P > 0.05). Conclusion:Early contiuous blood purification combined with Xingnaojing injection has significant effect in treating severe heat stroke. It can swiftly reduce the core body temperature, stabilize blood pressure, improve the disturbance of consciousness of patients and promote pulmonary oxygenation and whole-body perfusion.
Objective:To evaluate the clinical effect of early contiuous blood purification(CBP) combined with Xingnaojing injection for severe heat stroke. Methods:Selected 29 cases of patients with severe heat stroke who were admitted in ICU,and divided them into two groups randomly,14 cases in the treatment group and 15 cases in the control group. The control group received routine treatment,while the treatment group additionally received CBP combined with Xingnaojing injection.Observed the body temperature at admission,the time of body temperature deceasing to 38.5 ℃,the time of body temperature back to norm, the number of dysfunctional organs and hospitalization time in both groups; after 7 days of treatment,compared the changes in scores of Glasgow coma scale(GCS),heart rate(HR),mean arterial pressure(MAP),oxygenation index(PO_2/FiO 2),blood lactic acid(Lac) and APECHE II scores in both groups;statistically analyzed the hospitalization days,mortality rate and disability rate. Results:After treatment,the time of body temperature deceasing to 38.5 ℃,the time of body temperature back to norm and hospitalization time in the treatment group were significantly shorter than those in the control group,difference being significant(P < 0.05). Before treatment,comparing the scores of APECHE II and GCS,HR,MAP,PO_2/Fi O_2 and Lac,there were no significant differences being found(P > 0.05). After treatment,the scores of APECHE II,HR and Lac in both groups were lower than those before treatment,and the scores of GCS,MAP and PO_2/Fi O_2 were higher than those before treatment;the scores of APECHE II,HR and Lac in the treatment group were lower than those in the control group, and the scores of GCS, MAP and PO_2/FiO 2 were higher than in the control group, differences being significant(P < 0.05). Comparing the mortality rate and the disability rate in both groups,there was no significant difference being found(P > 0.05). Conclusion:Early contiuous blood purification combined with Xingnaojing injection has significant effect in treating severe heat stroke. It can swiftly reduce the core body temperature, stabilize blood pressure, improve the disturbance of consciousness of patients and promote pulmonary oxygenation and whole-body perfusion.
引文
[1]中华人民共和国卫生部.职业性中暑诊断标准[J].职业卫生与应急救援,2009,27(4):174.
[2]国家中医药管理局.ZY/T001.1~001.9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[3]苏磊.重症中暑防治回顾与启示[J].解放军医学杂志,2011,36(9):883-885.
[4]苏磊,郭振辉,钱洪津.重症中暑住院病人流行病学调查与分析[J].解放军医学杂志,2006,31(9):909-910.
[5]倪啸晓,刘志锋,谢秋幼,等.中暑脑损伤机制及高压氧治疗作用的研究进展[J].中华危重病急救医学,2017,29(6):572-576.
[6]徐元虎.醒脑静注射液的药理药效学研究与临床应用现状[J].现代中西医结合杂志,2010,19(4):507-510.
[2]国家中医药管理局.ZY/T001.1~001.9-94中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[3]苏磊.重症中暑防治回顾与启示[J].解放军医学杂志,2011,36(9):883-885.
[4]苏磊,郭振辉,钱洪津.重症中暑住院病人流行病学调查与分析[J].解放军医学杂志,2006,31(9):909-910.
[5]倪啸晓,刘志锋,谢秋幼,等.中暑脑损伤机制及高压氧治疗作用的研究进展[J].中华危重病急救医学,2017,29(6):572-576.
[6]徐元虎.醒脑静注射液的药理药效学研究与临床应用现状[J].现代中西医结合杂志,2010,19(4):507-510.