[摘要] 目的 探讨床旁重症超声评价参附注射液在休克患者治疗中的效果。方法 选取2022年1月至2024年5月南昌市第一医院收治的80例休克患者，根据是否应用参附注射液将其分为参附组（45例）和对照组（35例）。对照组患者给与常规西医治疗，参附组患者在对照组基础上加用参附注射液。分别于治疗的第１、3、7天记录超声测量指标及临床结果，比较两组患者的左室舒张末期内径（left ventricular end diastolic diameter，LVEDD）、左室射血分数（left ventricular ejection fraction，LVEF）、二尖瓣舒张早期峰值血流速度（E）/二尖瓣环舒张早期峰值运动速度（E’）、三尖瓣环收缩期位移（tricuspid annular plane systolic excusion，TAPSE）、右心室面积变化分数（right ventricular fractional area change，RVFAC）、下腔静脉变异率（inferior vena cava variation rate，IVCV）、心率（heart rate，HR）、平均动脉压（mean arterial pressure，MAP）、N末端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）、乳酸（lactic acid，Lac）、序贯器官衰竭评估（sequential organ failure assessment，SOFA）评分及30d生存状态。结果 治疗1d、3d、7d后，两组患者的LVEDD、E/E’逐渐减小，LVEF、TAPSE、RVFAC、IVCV逐渐增加（Plt;0.05）；治疗7d后，参附组患者的LVEF、TAPSE、RVFAC、IVCV显著高于对照组（Plt;0.05）。治疗7d后，两组患者的HR、NT-proBNP、Lac、SOFA评分均显著低于本组治疗前，MAP均显著高于本组治疗前（Plt;0.05）；参附组患者的HR、NT-proBNP、Lac、SOFA评分均显著低于对照组，MAP显著高于对照组，机械通气时间、重症监护病房入住时间均显著短于对照组（Plt;0.05）。Kaplan-Meier生存分析显示，参附组患者30d生存率显著高于对照组（82.22% vs. 54.28%，Plt;0.05）。结论 床旁重症超声显示参附注射液可有效改善休克患者的心室收缩及舒张功能，为休克治疗提供有价值的实时评估手段。

[关键词] 休克；参附注射液；床旁重症超声；心脏舒缩功能

[中图分类号] R445.1；R256.2" """"[文献标识码] A """""[DOI] 10.3969/j.issn.1673-9701.2025.19.011

Evaluation of cardiac function in patients with shock treated by Shenfu injection by ultrasound

LIU Hailan¹， LIU Tingting¹， JIANG Guanghui²， GAO Zhihui³

1.Department of Ultrasound， First Hospital of Nanchang， Nanchang 330008， Jiangxi， China; 2.Department of Critical Care Medicine， First Hospital of Nanchang， Nanchang 330008， Jiangxi， China; 3.Department of Critical Care Medicine， Yugan County People’s Hospital， Yugan 335100， Jiangxi， China

[Abstract] Objective To evaluate the therapeutic effect of Shenfu injection in shock patients by using bedside critical ultrasound. Methods A total of 80 shock patients admitted to First Hospital of Nanchang from January 2022 to May 2024 were selected and divided into Shenfu group （45 cases） and control group （35 cases） according to whether Shenfu injection was applied. Patients in control group were given conventional western medical treatment， while patients in Shenfu group were treated with Shenfu injection in addition to control group. The ultrasound measurement indicators and clinical results were recorded on the 1st， 3rd， and 7th days of treatment respectively， and left ventricular end diastolic diameter （LVEDD）， left ventricular ejection fraction （LVEF）， peak velocity of early diastolic flow of mitral valve （E）/ peak velocity of early diastolic motion of mitral annulus （E’）， tricuspid annular plane systolic excusion （TAPSE）， right ventricular fractional area change （RVFAC）， inferior vena cava variation rate （IVCV）， heart rate （HR）， mean arterial pressure （MAP）， N-terminal pro-brain natriuretic peptide （NT-proBNP）， lactic acid （Lac）， sequential organ failure assessment （SOFA） score and 30-day survival status of two groups of patients was compared. Results After 1 day， 3 days and 7 days of treatment， LVEDD and E/E’ of two groups of patients gradually decreased， while LVEF， TAPSE， RVFAC and IVCV gradually increased significantly （Plt;0.05）. After 7 days of treatment， the LVEF， TAPSE， RVFAC and IVCV of patients in Shenfu group were significantly higher than those in control group （Plt;0.05）. After 7 days of treatment， the HR， NT-proBNP， Lac and SOFA scores of two groups of patients were significantly lower than those before treatment in same group， and the MAP was significantly higher than that before treatment in same group （Plt;0.05）. The HR， NT-proBNP， Lac and SOFA scores of patients in Shenfu group were significantly lower than those in control group， the MAP was significantly higher than that in control group， and the mechanical ventilation time and the length of stay in intensive care unit were significantly shorter than those in control group （Plt;0.05）. Kaplan-Meier survival analysis showed that 30-day survival rate of patients in Shenfu group was significantly higher than that in control group （82.22% vs. 54.28%， Plt;0.05）. Conclusion Bedside critical ultrasound showed that Shenfu injection could effectively improve ventricular systolic and diastolic function in shock patients， providing a valuable real-time assessment tool for shock treatment.

[Key words] Shock; Shenfu injection; Bedside critical ultrasound; Cardiac systolic and diastolic function

休克是机体在受到各种严重致病因素侵袭后所发生的以有效循环血量急剧减少、组织血液灌注量严重不足为特征，导致细胞缺氧以致各重要脏器功能代谢紊乱和结构损害的全身性病理生理变化及临床病程。……