参附注射液联合甘露醇、HSH40对急性颅内高压合并失血性休克患者脑氧代谢、脑血流动力学、炎性反应及预后的影响
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摘要
目的观察参附注射液联合甘露醇、高渗氯化钠羟乙基淀粉40注射液(HSH40)对急性颅内高压合并失血性休克患者脑氧代谢、脑血流动力学、炎性反应及预后的影响。方法将60例急性颅内高压合并失血性休克患者随机分为对照组和观察组,每组30例。对照组给予甘露醇+HSH40治疗,观察组在对照组基础上给予参附注射液治疗。记录2组治疗前(t_0)、治疗后30 min(t_1)、治疗后60 min(t_2)、治疗后120 min(t_3)循环系统指标、颅内压(ICP)、脑氧代谢指标、脑血流动力学参数、血清炎症细胞因子的变化,比较2组休克指数(SI)、美国国立卫生院神经功能缺损(NIHSS)评分、格拉斯哥预后评分(GOS)的差异。结果 2组t_1～t_3时的平均动脉压(MAP)、中心静脉压(CVP)、颈静脉球血氧饱和度、大脑中动脉收缩期血流速度(Vp)和舒张期血流速度(Vd)均较t_0时显著增高(P均<0.05),心率(HR)、ICP、脑动静脉血氧含量差、阻力指数(RI)和搏动指数(PI)均较t_0时显著降低(P均<0.05),观察组t_1～t_3时上述各指标改善情况均显著优于对照组(P均<0.05)。2组t_1～t_3时的血清白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均较t_0显著降低(P均<0.05),观察组以上指标在t_1～t_3时均显著低于对照组(P均<0.05)。2组t_3时间点SI均显著降低(P均<0.05),且观察组显著低于对照组(P<0.05)。2组治疗后均随访1个月,观察组随访时NIHSS评分显著低于对照组(P<0.05),GOS评分显著高于对照组(P<0.05)。结论在对急性颅内高压合并失血性休克患者实施甘露醇和HSH40液体复苏的基础上,加用参附注射液可有效促进患者复苏,降低颅内压,改善脑氧代谢和血流灌注,抑制炎症反应,有利于神经功能和预后康复。
Objective It is to observe the effects of Shenfu injection combined with mannitol and hypertonic sodium chloride hydroxyethyl starch 40 injection(HSH40) on cerebral oxygen metabolism, cerebral hemodynamics, inflammatory response and prognosis in patients with acute intracranial hypertension complicated with hemorrhagic shock. Methods Sixty patients with acute intracranial hypertension and hemorrhagic shock were randomly divided into control group and observation group, 30 cases in each group. The control group was treated with mannitol+HSH40, and the observation group was additionally given Shenfu injection on the basis of the control group.The changes of circulatory system index, intracranial pressure(ICP), cerebral oxygen metabolism indexes,cerebral hemodynamics parameters, serum inflammatory cytokines before treatment(t_0), at 30 minutes after treatment(t_1), 60 minutes after treatment(t_2), 120 minutes after treatment(t_3) were recorded, and the differences in shock index(SI), NIHSS scores, and Glasgow Outcome Score(GOS) between the two groups were compared. Results Mean arterial pressure(MAP), central venous pressure(CVP), jugular bulb oxygen saturation, middle cerebral artery systolic blood flow velocity(Vp) and diastolic blood flow velocity(Vd) at the t_1 to t_3 time points in the 2 groups were significantly higher, while the heart rate(HR), ICP, difference of cerebral arteriovenous blood oxygen content, resistance index(RI) and pulsatility index(PI) were significantly lower than those at t0 time point in the two groups(P<0.05), the improvement of the above indicators at t_1～t_3 time point in the observation group were significantly better than those in the control group(P<0.05). The levels of serum interleukin-6(IL-6), IL-8, tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) in the two groups from t_1 to t_3 were significantly lower than those at t_0(P<0.05), and the above indicators in the observation group were significantly lower than the control group at the time of t_1～t_3(P<0.05). The SI of the two groups at t_3 was significantly decreased(P<0.05), and SI in the observation group was significantly lower than the control group(P<0.05). The two groups were followed up for 1 month after treatment,the NIHSS scores were significantly lower and the GOS scores were significantly higher in the observation group than the control group(P<0.05). Conclusion Based on the liquid resuscitation of mannitol and HSH40 in patients with acute intracranial hypertension and hemorrhagic shock, the addition of Shenfu injection can effectively promote the recovery of patients, reduce intracranial pressure, improve cerebral oxygen metabolism and blood perfusion, and inhibit inflammation,it is beneficial to the recovery of neurological function and prognosis.
Objective It is to observe the effects of Shenfu injection combined with mannitol and hypertonic sodium chloride hydroxyethyl starch 40 injection(HSH40) on cerebral oxygen metabolism, cerebral hemodynamics, inflammatory response and prognosis in patients with acute intracranial hypertension complicated with hemorrhagic shock. Methods Sixty patients with acute intracranial hypertension and hemorrhagic shock were randomly divided into control group and observation group, 30 cases in each group. The control group was treated with mannitol+HSH40, and the observation group was additionally given Shenfu injection on the basis of the control group.The changes of circulatory system index, intracranial pressure(ICP), cerebral oxygen metabolism indexes,cerebral hemodynamics parameters, serum inflammatory cytokines before treatment(t_0), at 30 minutes after treatment(t_1), 60 minutes after treatment(t_2), 120 minutes after treatment(t_3) were recorded, and the differences in shock index(SI), NIHSS scores, and Glasgow Outcome Score(GOS) between the two groups were compared. Results Mean arterial pressure(MAP), central venous pressure(CVP), jugular bulb oxygen saturation, middle cerebral artery systolic blood flow velocity(Vp) and diastolic blood flow velocity(Vd) at the t_1 to t_3 time points in the 2 groups were significantly higher, while the heart rate(HR), ICP, difference of cerebral arteriovenous blood oxygen content, resistance index(RI) and pulsatility index(PI) were significantly lower than those at t0 time point in the two groups(P<0.05), the improvement of the above indicators at t_1～t_3 time point in the observation group were significantly better than those in the control group(P<0.05). The levels of serum interleukin-6(IL-6), IL-8, tumor necrosis factor-α(TNF-α) and C-reactive protein(CRP) in the two groups from t_1 to t_3 were significantly lower than those at t_0(P<0.05), and the above indicators in the observation group were significantly lower than the control group at the time of t_1～t_3(P<0.05). The SI of the two groups at t_3 was significantly decreased(P<0.05), and SI in the observation group was significantly lower than the control group(P<0.05). The two groups were followed up for 1 month after treatment,the NIHSS scores were significantly lower and the GOS scores were significantly higher in the observation group than the control group(P<0.05). Conclusion Based on the liquid resuscitation of mannitol and HSH40 in patients with acute intracranial hypertension and hemorrhagic shock, the addition of Shenfu injection can effectively promote the recovery of patients, reduce intracranial pressure, improve cerebral oxygen metabolism and blood perfusion, and inhibit inflammation,it is beneficial to the recovery of neurological function and prognosis.
引文
[1] 薄克燚.人血白蛋白水平与中重度颅脑损伤预后的相关性研究[J].中国临床医生杂志,2018,46(11):1311-1313
[2] 周琪,黄淮,许沛,等.高渗盐复合液治疗急性颅内高压伴失血性休克患者的临床观察[J].中华急诊医学杂志,2017,26(4):426-429
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[5] 中华医学会神经病学分会神经重症协作组,中国医师协会神经内科医师分会神经重症专业委员会.难治性颅内压增高的监测与治疗中国专家共识[J].中华医学杂志,2018,98(45):3643-3652
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[8] 刘杰,李青松,温韬雪,等.高渗氯化钠液对重型颅脑损伤患者脑氧代谢的影响[J].西南国防医药,2018,28(4):323-326
[9] 肖玲燕,顾勤,刘宁,等.功能磁共振监测家兔失血性休克早期脑代谢及脑血流的变化[J].现代医学,2017,45(10):1391-1395
[10] 牟连生,刘皇勇,杨渊,等.颅脑创伤后脑血流动力学参数与颅内压、脑灌注压及预后的相关性研究[J].检验医学与临床,2017,14(7):1036-1038
[11] 栾宏权,黄贤键,姚柱炜,等.颅脑损伤患者血小板参数及无创脑血流动力学变化的临床意义[J].血栓与止血学,2016,22(3):260-263
[12] 刘岱,杨虎银.高压氧对重型颅脑损伤患者血清炎性因子、氧化应激、内皮素及颅内压的影响[J].海南医学院学报,2017,23(5):651-654
[13] 刘凤平.亚低温护理干预对失血性休克患者血清炎性因子及预后的改善作用[J].中国乡村医药,2017,24(23):74-75
[14] 陈凛,崔建新.限制性液体复苏治疗创伤失血性休克争议与共识[J].中国实用外科杂志,2015,35(2):167-171
[15] 陈向荣,周金良,黄志研,等.甘露醇联合白蛋白治疗颅脑损伤致颅内压增高的效果观察[J].中国医药科学,2018,8(22):213-215
[16] 刘变化,张思森,王国涛,等.高渗氯化钠羟乙基淀粉40注射液对创伤失血性休克兔血浆内皮素-1水平的影响[J].新乡医学院学报,2016,33(3):178-181
[17] 陈珍爱,赵崇汉,袁秀仪,等.HSH40联合甘露醇救治颅内高压合并失血性休克[J].深圳中西医结合杂志,2016,26(12):18-19
[18] 周洋,陈武荣.失血性休克中医药复合液体治疗的新进展[J].中国医药导刊,2009,11(10):1708-1709
[19] 袁雯.附子的药理研究[J].中医临床研究,2018,10(4):145-147
[20] 江其影,陈矛,薛秋平,等.参附注射液联合血必净注射液对ICU脓毒性休克患者中医证候积分、血清炎症因子水平及血流动力学指标的影响[J].中国中医急症,2018,27(9):1612-1615
[2] 周琪,黄淮,许沛,等.高渗盐复合液治疗急性颅内高压伴失血性休克患者的临床观察[J].中华急诊医学杂志,2017,26(4):426-429
[3] 张颖.早期限制性液体复苏抢救重度颅脑外伤合并失血性休克患者疗效分析[J].临床军医杂志,2017,45(4):412-415
[4] 肖华平,程其许,杨小敏,等.高渗氯化钠羟乙基40淀粉注射液对急性颅脑损伤患者细胞因子及神经功能预后的影响研究[J].中国全科医学,2017,20(35):4362-4366
[5] 中华医学会神经病学分会神经重症协作组,中国医师协会神经内科医师分会神经重症专业委员会.难治性颅内压增高的监测与治疗中国专家共识[J].中华医学杂志,2018,98(45):3643-3652
[6] 中国医师协会急诊分会.创伤失血性休克诊治中国急诊专家共识[J].中华急诊医学杂志,2017,26(12):1029-1038
[7] 李铮.高渗盐复合液与甘露醇治疗急性颅内高压伴失血性休克的对比研究[J].现代实用医学,2017,29(10):1331-1333
[8] 刘杰,李青松,温韬雪,等.高渗氯化钠液对重型颅脑损伤患者脑氧代谢的影响[J].西南国防医药,2018,28(4):323-326
[9] 肖玲燕,顾勤,刘宁,等.功能磁共振监测家兔失血性休克早期脑代谢及脑血流的变化[J].现代医学,2017,45(10):1391-1395
[10] 牟连生,刘皇勇,杨渊,等.颅脑创伤后脑血流动力学参数与颅内压、脑灌注压及预后的相关性研究[J].检验医学与临床,2017,14(7):1036-1038
[11] 栾宏权,黄贤键,姚柱炜,等.颅脑损伤患者血小板参数及无创脑血流动力学变化的临床意义[J].血栓与止血学,2016,22(3):260-263
[12] 刘岱,杨虎银.高压氧对重型颅脑损伤患者血清炎性因子、氧化应激、内皮素及颅内压的影响[J].海南医学院学报,2017,23(5):651-654
[13] 刘凤平.亚低温护理干预对失血性休克患者血清炎性因子及预后的改善作用[J].中国乡村医药,2017,24(23):74-75
[14] 陈凛,崔建新.限制性液体复苏治疗创伤失血性休克争议与共识[J].中国实用外科杂志,2015,35(2):167-171
[15] 陈向荣,周金良,黄志研,等.甘露醇联合白蛋白治疗颅脑损伤致颅内压增高的效果观察[J].中国医药科学,2018,8(22):213-215
[16] 刘变化,张思森,王国涛,等.高渗氯化钠羟乙基淀粉40注射液对创伤失血性休克兔血浆内皮素-1水平的影响[J].新乡医学院学报,2016,33(3):178-181
[17] 陈珍爱,赵崇汉,袁秀仪,等.HSH40联合甘露醇救治颅内高压合并失血性休克[J].深圳中西医结合杂志,2016,26(12):18-19
[18] 周洋,陈武荣.失血性休克中医药复合液体治疗的新进展[J].中国医药导刊,2009,11(10):1708-1709
[19] 袁雯.附子的药理研究[J].中医临床研究,2018,10(4):145-147
[20] 江其影,陈矛,薛秋平,等.参附注射液联合血必净注射液对ICU脓毒性休克患者中医证候积分、血清炎症因子水平及血流动力学指标的影响[J].中国中医急症,2018,27(9):1612-1615