干预措施:
Interventions:
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组别:
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加味犀角地黄汤联合常规西医治疗
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样本量:
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30
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Group:
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Supplemented Xijiao Dihuang Tang combined with conventional Western medicine treatment group
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Sample size:
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干预措施:
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口服或者鼻饲加味犀角地黄汤联合常规西医治疗,包括①初始液体复苏:对脓毒症所致的低灌注或休克患者3小时内至少静脉注射30ml/kg晶体液;②使用动态监测手段来指导液体复苏,如每搏量(SV)、每搏量变异(SVV)、脉压变异(PPV)及心脏超声;③抗生素的使用:对疑似脓毒性休克或脓毒症的患者,在明确诊断的1小时内立即开展抗感染治疗;④血管活性药的使用:对脓毒性休克患者,去甲肾上腺素作为首选升压药;对使用去甲肾上腺素后平均动脉压(MAP)水平仍不能达标,联合使用血管加压素;⑤机械通气:对脓毒症所致急性呼吸窘迫综合征患者,采取肺保护性通气策略,包括小潮气量(6ml/kg),较高呼气末正压(PEEP),其上限目标设定为30cmH2O。对脓毒症所致中重度急性呼吸窘迫综合征患者,每天俯卧位通气时间≥12小时,对脓毒症所致严重急性呼吸窘迫综合征患者,常规机械通气治疗失败时,可予以静脉-静脉体外膜肺氧合(VV-ECMO)治疗;⑥补充治疗:对于脓毒性休克且需要持续使用升压药的患者(去甲肾上腺素用量≥0.25mg·kg-1·min-1),予以使用糖皮质激素,在排除相关禁忌症后予以低分子肝素预防深静脉血栓形成,对脓毒症或脓毒性休克所致的急性肾损伤(AKI),且需要进行肾脏替代治疗的患者,予以连续性肾脏替代治疗,对于脓毒症患者血糖控制目标为8-10mmol/L,对于可以耐受肠内营养的患者在72小时内启动肠内营养支持治疗。
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干预措施代码:
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Intervention:
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Oral or nasal feeding Supplemented Xijiao Dihuang Tang combined with conventional Western medicine treatment, including ① initial fluid resuscitation: patients with hypoperfusion or shock due to sepsis should be given at least 30ml/kg crystal solution intravenously within 3 hours; (2) Use dynamic monitoring to guide fluid resuscitation, such as stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), and echocardiography; ③ The use of antibiotics: for suspected septic shock or sepsis patients, anti-infection therapy should be carried out immediately within 1 hour of definite diagnosis; (4) Use of vasoactive agents: norepinephrine is the first choice for patients with septic shock. The mean arterial pressure (MAP) level after norepinephrine was still not up to the standard, and vasopressin was used in combination. ⑤ Mechanical ventilation: For patients with acute respiratory distress syndrome(ARDS) caused by sepsis, pulmonary protective ventilation strategies, including small tidal volume (6ml/kg), high positive end expiratory pressure (PEEP), and the upper target is set at 30cmH2O. For moderate and severe ARDS patients caused by sepsis, ventilation time should be ≥12 hours per day in prone position. For severe ARDS patients caused by sepsis, veno-venous extracorporeal membrane oxygenation (VV-ECMO) can be used when conventional mechanical ventilation fails. ⑥ Supplementary treatment: In patients with septic shock requiring continued use of pressors (norepinephrine ≥0.25mg·kg-1·min-1), corticosteroids should be administered, low molecular weight heparin should be administered to prevent deep vein thrombosis after contraindications are excluded, acute kidney injury due to sepsis or septic shock (AKI) should be treated. In addition, continuous renal replacement therapy was given to patients who needed renal replacement therapy. For patients with sepsis, the blood glucose control target was 8-10mmol/L, and for patients who could tolerate enteral nutrition, enteral nutrition support therapy was initiated within 72 hours.
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Intervention code:
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组别:
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常规西医治疗组
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样本量:
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30
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Group:
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Conventional western medicine treatment group
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Sample size:
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干预措施:
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常规西医治疗按照《拯救脓毒症运动:脓毒症与脓毒性休克治疗国际指南(2021)》,包括①初始液体复苏:对脓毒症所致的低灌注或休克患者3小时内至少静脉注射30ml/kg晶体液;②使用动态监测手段来指导液体复苏,如每搏量(SV)、每搏量变异(SVV)、脉压变异(PPV)及心脏超声;③抗生素的使用:对疑似脓毒性休克或脓毒症的患者,在明确诊断的1小时内立即开展抗感染治疗;④血管活性药的使用:对脓毒性休克患者,去甲肾上腺素作为首选升压药;对使用去甲肾上腺素后平均动脉压(MAP)水平仍不能达标,联合使用血管加压素;⑤机械通气:对脓毒症所致急性呼吸窘迫综合征患者,采取肺保护性通气策略,包括小潮气量(6ml/kg),较高呼气末正压(PEEP),其上限目标设定为30cmH2O。对脓毒症所致中重度急性呼吸窘迫综合征患者,每天俯卧位通气时间≥12小时,对脓毒症所致严重急性呼吸窘迫综合征患者,常规机械通气治疗失败时,可予以静脉-静脉体外膜肺氧合(VV-ECMO)治疗;⑥补充治疗:对于脓毒性休克且需要持续使用升压药的患者(去甲肾上腺素用量≥0.25mg·kg-1·min-1),予以使用糖皮质激素,在排除相关禁忌症后予以低分子肝素预防深静脉血栓形成,对脓毒症或脓毒性休克所致的急性肾损伤(AKI),且需要进行肾脏替代治疗的患者,予以连续性肾脏替代治疗,对于脓毒症患者血糖控制目标为8-10mmol/L,对于可以耐受肠内营养的患者在72小时内启动肠内营养支持治疗。
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干预措施代码:
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Intervention:
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Conventional Western medicine treatment follows the Campaign to Save Sepsis: International Guidelines for the Treatment of Sepsis and Septic Shock (2021), including ① Initial fluid resuscitation: intravenous injection of at least 30ml/kg crystal solution within 3 hours for patients with hypoperfusion or shock due to sepsis; (2) Use dynamic monitoring to guide fluid resuscitation, such as stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), and echocardiography; ③ The use of antibiotics: for suspected septic shock or sepsis patients, anti-infection therapy should be carried out immediately within 1 hour of definite diagnosis; (4) Use of vasoactive agents: norepinephrine is the first choice for patients with septic shock. The mean arterial pressure (MAP) level after norepinephrine was still not up to the standard, and vasopressin was used in combination. ⑤ Mechanical ventilation: For patients with acute respiratory distress syndrome caused by sepsis, pulmonary protective ventilation strategies, including small tidal volume (6ml/kg), high positive end expiratory pressure (PEEP), and the upper target is set at 30cmH2O. For patients with moderate to severe acute respiratory distress syndrome caused by sepsis, ventilation time should be ≥12 hours per day in prone position. For patients with severe acute respiratory distress syndrome caused by sepsis, veno-venous extracorporeal membrane oxygenation (VV-ECMO) can be used when conventional mechanical ventilation fails. ⑥ Supplementary treatment: In patients with septic shock requiring continued use of pressors (norepinephrine ≥0.25mg·kg-1·min-1), corticosteroids should be administered, low molecular weight heparin should be administered to prevent deep vein thrombosis after contraindications are excluded, acute kidney injury due to sepsis or septic shock (AKI) should be treated. In addition, continuous renal replacement therapy was given to patients who needed renal replacement therapy. For patients with sepsis, the blood glucose control target was 8-10mmol/L, and for patients who could tolerate enteral nutrition, enteral nutrition support therapy was initiated within 72 hours.
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Intervention code:
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