HAT疗法治疗脓毒症休克的临床疗效观察

doi:10.11958/20240083

摘要/Abstract

摘要：

目的探讨氢化可的松、维生素C及维生素B1（HAT）疗法治疗脓毒症休克的效果及对血管活性药物应用时间、血流动力学参数及近期预后的影响。方法 92例脓毒症休克患者，根据治疗方案的不同分为HAT组和常规治疗组，各46例。常规治疗组给予抗感染、补液、稳定血压、连续性肾脏替代治疗（CRRT），HAT组在常规治疗组基础上给予HAT疗法辅助治疗，均连续治疗3 d。比较2组疗效相关指标和治疗前后急性生理与慢性健康（APACHEⅡ）评分、序贯器官衰竭评估（SOFA）评分、平均动脉压（MAP）、心率（HR）、中心动脉压（CAP）和D-乳酸（D-Lac）、肌酐（Cr）、超敏C反应蛋白（hs-CRP）、降钙素原（PCT）水平、不良反应发生率及随访28 d生存率。结果 HAT组循环稳定时间、血管活性药物应用时间、激素使用时间、机械通气时间、CRRT时间、ICU治疗时间和总住院时间短于常规治疗组（P<0.05）；治疗后，HAT组APACHEⅡ评分、SOFA评分、HR、D-Lac、Cr、hs-CRP和PCT水平低于常规治疗组，MAP、CAP高于常规治疗组（P<0.05）；HAT组28 d生存率为65.22%，高于常规治疗组的45.65%（P<0.05）。结论 HAT疗法可提高脓毒症休克患者临床疗效，缩短血管活性药物应用时间，改善血流动力学参数及近期预后。

关键词: 休克, 脓毒性, 氢化可的松, 维生素C, 维生素B1, 血流动力学, 近期预后

Abstract:

Objective To explore the curative effect of hydrocortisone ascorbic acid, vitamin C and vitamin B1 (HAT) therapy on septic shock and its influence on the time of vasoactive drug application, hemodynamic parameters and short-term prognosis. Methods According to different treatment plans, 92 patients with septic shock were divided into the HAT group and the routine treatment group, 46 cases in each group. The routine treatment group was given routine treatments [anti-infection, fluid replacement, stabling blood pressure and continuous renal replacement therapy (CRRT)], while the HAT group was additionally given HAT therapy. All patients were treated continuously for 3 d. The indexes related the curative effect, scores of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) and sequential organ failure assessment (SOFA), levels of mean arterial pressure (MAP), heart rate (HR), central arterial pressure (CAP), D-lactic acid (D-Lac), creatinine (Cr), hypersensitive C-reactive protein (hs-CRP) and procalcitonin (PCT) before and after treatment, incidence of adverse reactions and 28 d survival rate by follow-up were compared between the two groups. Results The circulation stabilization time, use time of vasoactive drugs and hormones, mechanical ventilation time, CRRT time, treatment time in ICU and total hospitalization time were shorter in the HAT group than those in the routine treatment group (P<0.05). After 7 d of treatment, scores of APACHE Ⅱand SOFA, levels of HR, D-Lac, Cr, hs-CRP and PCT were lower in the HAT group than those in the routine treatment group, while MAP and CAP were higher than those in the routine treatment group (P<0.05). The 28-day survival rate was 65.22% in the HAT group, which was higher than that in the routine treatment group (45.65%, P<0.05). Conclusion HAT therapy can improve clinical curative effect in patients with septic shock, shorten use time of vasoactive drugs, improve hemodynamic parameters and short-term prognosis.

Key words: shock, septic, hydrocortisone, vitamin C, vitamin B1, hemodynamics, short-term prognosis

中图分类号:

R453

图/表 6

参考文献 25

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组别	年龄/岁	男性	原发病
组别	年龄/岁	男性	重症肺炎	重症胰腺炎	腹腔感染	重症胆囊炎
常规治疗组	57.0±5.9	21（45.7）	12（26.1）	15（32.6）	11（23.9）	8（17.4）
HAT组	59.4±6.3	28（60.9）	17（37.0）	10（21.7）	13（28.3）	6（13.0）
t或χ²	1.904	2.140	2.314

组别	年龄/岁	男性	原发病
组别	年龄/岁	男性	重症肺炎	重症胰腺炎	腹腔感染	重症胆囊炎
常规治疗组	57.0±5.9	21（45.7）	12（26.1）	15（32.6）	11（23.9）	8（17.4）
HAT组	59.4±6.3	28（60.9）	17（37.0）	10（21.7）	13（28.3）	6（13.0）
t或χ²	1.904	2.140	2.314

组别	循环稳定时间/h	血管活性药物应用时间/d	激素使用时间/d	机械通气时间/d	CRRT时间/d	ICU治疗时间/d	总住院时间/d
常规治疗组	13.27±2.62	5.95±1.03	3.25±0.41	7.91±1.27	12.61±1.89	14.57±2.06	18.92±4.12
HAT组	9.08±1.75	2.26±0.34	1.96±0.20	5.68±0.35	10.03±1.27	11.74±1.53	15.79±3.65
t	9.020^＊＊	13.073^＊＊	23.072^＊＊	11.481^＊＊	7.685^＊＊	7.480^＊＊	3.857^＊＊

组别	循环稳定时间/h	血管活性药物应用时间/d	激素使用时间/d	机械通气时间/d	CRRT时间/d	ICU治疗时间/d	总住院时间/d
常规治疗组	13.27±2.62	5.95±1.03	3.25±0.41	7.91±1.27	12.61±1.89	14.57±2.06	18.92±4.12
HAT组	9.08±1.75	2.26±0.34	1.96±0.20	5.68±0.35	10.03±1.27	11.74±1.53	15.79±3.65
t	9.020^＊＊	13.073^＊＊	23.072^＊＊	11.481^＊＊	7.685^＊＊	7.480^＊＊	3.857^＊＊

组别	APACHEⅡ评分		t₂	SOFA评分		t₂
组别	治疗前	治疗后	t₂	治疗前	治疗后	t₂
常规治疗组	25.0±2.7	16.7±1.8	19.011^＊＊	14.1±2.2	7.5±1.3	16.066^＊＊
HAT组	24.1±2.1	11.1±1.3	31.607^＊＊	13.6±1.7	5.4±0.7	31.517^＊＊
t₁	1.754	16.985^＊＊		1.079	10.142^＊＊