大黄附子汤对失血性休克急性肺损伤患者保护作用.docVIP

大黄附子汤对失血性休克急性肺损伤患者保护作用 　　【摘要】目的探讨大黄附子汤防治失血性休克并发急性肺损伤的保护作用及其机理。方法采用前瞻性、多中心、随机对照临床试验。收集2010年6月至2013年4月大连地区3所三级甲等医院87例失血性休克并发急性肺损伤患者的临床资料，采用随机数字法分为对照组（n=42）和大黄附子汤灌肠组（试验组，n=45）。于患者入组时及治疗1、3、7 d分别取静脉血测定肿瘤坏死因子α（TNF-α）、C反应蛋白（CRP）、血乳酸、内毒素质量浓度；测定血管外肺水指数（EVLWI）、EVLW/ ITBV（胸腔内总血容量）、平均动脉压（MAP）、心脏指数（CI）；测定静态肺顺应性、呼吸道阻力以及呼吸机撤离时间、低氧血症纠正时间，计算患者病死率。采用SPSS 17.0软件分析实验数据，组内比较采用方差分析，两两比较采用LSD-t检验。结果与对照组比较，试验组在大黄附子汤治疗后各时间点血清TNF-α、CRP、内毒素、血乳酸、EVLWI 及EVLW/ITBV显著降低（P 　　【关键词】失血性休克；急性肺损伤；大黄附子汤；内毒素；血管外肺水；静态肺顺应性；呼吸道阻力；病死率；患者 　　Protective effect of DaHuang Fuzi Decoction on hemorrhagic shock secondary to acute lung injury in patients LU Xiao-guang*， KANG Xin， ZHAN Li-bin，YU Jian， YANG Rong-li， FAN Zhi-wei ，XIAO Wei-qiang，LI Si-yao， Liang Zheng-kai， YU Jie， YU Liang-liang. *Department of Emergency Medicine， Affiliated Zhongshan Hospital of Dalian University， Dalian 116001 China 　　Corresponding author：LU Xiao-guang，Email：dllxg@126.com 　　【Abstract】ObjectiveTo discuss protective effect of DaHuang Fuzi Decoction （a Chinese herbal preparation made of Rheum palmatum L and Aconitum carmichaeli Debx） on hemorrhagic shock induced by acute lung injury in patients.MethodsA prospective， multiple-center， randomized（random number） and controlled clinical trial was carried out in 87 adult patients with hemorrhagic shock secondary to acute lung injury admitted in intensive care unit （ICU） of 3 tertiary care hospitals in Dalian city. Patients were randomly（random number） divided into control group （n=42） and DaHuang Fuzi Decoction enemas group （experimental group， n=45）. Of 42 patients of control group， there were 28 male and 14 female with average age （39.68±15.77 ）years ranged from 20 to 64 years， and in experimental group， there were 30 male and 15 female with average age （42.12±14.87） years ranged from 20 to 68 years. The serum levels of TNF-α， C-reactive protein （CRP）， lactic acid and endotoxin， and extravascular lung water index， ratio of extravascular lung water to intrathoracic blood volume （EVLW/ITBV