血必净注射液对脓毒性休克患者凝血功能及炎症因子的影响

发布时间：2018-01-23 12:58

本文关键词： 血必净注射液脓毒性休克凝血功能炎症因子　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:脓毒症(Sepsis)是由炎症感染引起的临床重症[1],脓毒性休克(Septic shock)是由炎症引起的全身严重炎症反应和(或)器官障碍的综合征,又叫感染性休克[2],机体感染时大量白介素、肿瘤坏死因子等炎症因子合成、释放入血液或体液中,血管内皮功能损伤导致血管通透性急剧增加,凝血因子Ⅻ从而被活化,启动内源性凝血系统,血液浓缩,微血管内形成微血栓,导致微循环障碍,各种因素相互促进、影响,严重时诱发多器官衰竭(MODS)[3]。研究发现,脓毒症死亡率与凝血功能异常程度呈正相关性[4]。血必净注射液能清除内毒素、白介素、肿瘤坏死因子等炎症因子,改善细胞缺氧,具有活血化瘀、清热解毒之功效[5],同时还具有增强体液免疫功能的作用[6]。本研究采用血必净注射液治疗脓毒性休克,观察其炎症因子、乳酸水平及凝血功能变化,探讨血必净注射液对脓毒性休克的临床治疗作用。方法:所有患者均按照指南要求进行液体复苏、血管活性药物、合理抗生素、强化胰岛素、保护肝肾功能、预防应激性溃疡、营养支持等治疗[7],干预组在对照组基础上加用血必净注射液,每日2次,疗程为一周。两组患者分别于治疗前、治疗1d、3d、7d、14d后抽血测定血乳酸、凝血酶原时间、活化部分凝血活酶时间、血小板计数及TNF-α、IL-1、IL-6水平变化。凝血酶原时间、活化部分凝血活酶时间采用日本Sysmex CA7000全自动凝血分析仪。血小板计数采用全自动五分类血液细胞分析仪测定。TNF-α、IL-1、IL-6采用酶联免疫吸附法测定。结果:1两组一般情况比较:对照组25例,其中男性11例,女性14例,年龄33-65岁,平均年龄59.23±10.69岁,体重69.29±12.25kg,其中高血压5例、冠心病8例、高脂血症12例、脑梗死后遗症3例;干预组25例,其中男性13例,女性12例,年龄30-64岁,平均年龄59.23±11.34岁,体重72.34±12.50kg,其中高血压6例、冠心病7例、高脂血症10例、脑梗死后遗症5例。两组患者一般情况比较差异均无统计学意义。2两组凝血功能比较:治疗前、治疗第1天、第3天两组患者PT、APTT比较差异无统计学意义。治疗第7天、第14天,干预组患者PT、APTT比对照组明显缩短(P0.05)。3两组血小板比较:治疗前、治疗第1天、第3天两组患者血小板计数比较差异无统计学意义。治疗第7、14天干预组血小板计数比对照组明显升高(P0.05)。治疗前后两组同组比较差异有统计学意义(F对照组=60.262,P0.05;F干预组=119.414,P0.05),治疗第7、14天,两组血小板计数均较治疗前升高(P0.05)。4两组血乳酸水平比较:治疗前后两组患者血乳酸水平比较差异无统计学意义。两组治疗前后同组比较差异有统计学意义(F对照组=76.973,P0.05;F干预组=82.004,P0.05),治疗第1天、3天、7天、14天两组患者血乳酸水平均较治疗前下降。5两组TNF-α、IL-1、IL-6水平比较:治疗前、治疗第1天两组患者TNF-α、IL-1、IL-6水平比较差异无统计学意义。治疗第3天、7天、14天,干预组TNF-α、IL-1、IL-6水平低于对照组(P0.05)。干预组治疗前后比较有统计学意义(FTNF-α=104.952,P0.05;FIL-1=437.422,P0.05;FIL-6=887.459,P0.05),第7天比第3天TNF-α、IL-1、IL-6水平降低,第14天比第7天TNF-α、IL-1、IL-6水平降低(P0.05)。6两组14天病死率比较:干预组总病死率稍低于对照组,但两组差异无统计学意义。结论:1血必净注射液能改善脓毒性休克患者凝血功能(PT、APTT缩短),可能在某种程度上提高血小板数量。2血必净注射液能明显降低血清TNF-α、IL-1、IL-6表达水平。3血必净注射液不能改善脓毒性休克患者病死率。
[Abstract]:Objective: sepsis (Sepsis) is caused by severe clinical [1] infection, septic shock (Septic shock) is caused by inflammation, severe systemic inflammation and organ dysfunction syndrome (or), also called septic shock [2] infection a lot of interleukin, tumor necrosis factor and inflammation cytokine synthesis, release into the blood or body fluids, vascular endothelial function injury induced vascular permeability increased dramatically, Hageman factor can be activated, start the blood coagulation system, endogenous blood concentration, microvascular microthrombus, lead to microcirculation obstacle factors to promote each other and influence, serious when induced multiple organ failure (MODS) [3]. the study found that the mortality rate of sepsis and abnormal coagulation function were positively correlation between [4]. of Xuebijing injection to remove endotoxin, interleukin, tumor necrosis factor and other inflammatory factors, improve hypoxia, with blood stasis, clearing Heat and toxic substances [5], [6]. also has the enhancement of humoral immune function in this study by Xuebijing injection in the treatment of septic shock, to observe the changes of inflammatory cytokines, lactic acid and blood coagulation function, clinical treatment of Xuebijing Injection on septic shock were used. Method: all the patients were in accordance with the guidelines for fluid resuscitation, vasoactive drugs, antibiotics, insulin, liver and renal function, prevention of stress ulcer, nutritional support treatment [7], intervention group on the basis of the control group and Xuebijing injection, 2 times a day, lasted for a week. Two groups of patients before treatment, treatment of 1D, 3D, 7d, 14d blood serum lactic acid, prothrombin time, activated partial thromboplastin time, platelet count and serum TNF-, IL-1, IL-6 level changes. Prothrombin time, activated partial thromboplastin time by Japan Sysmex CA7 000 Automatic Coagulation Analyzer. The determination of.TNF- alpha, automatic five classification blood cell analyzer using platelet count IL-1, IL-6 was measured by ELISA. Results: compared with two groups of 1 general situation: 25 cases in the control group, there were 11 males and 14 females, aged 33-65 years, mean age 59.23 + 10.69 years old, weight 69.29 + 12.25kg, including 5 cases of hypertension, 8 cases of coronary heart disease, 12 cases of hyperlipidemia, 3 cases of sequelae of cerebral infarction; 25 cases in the intervention group, there were 13 males and 12 females, aged 30-64 years, mean age 59.23 + 11.34 years old, weighing 72.34 12.50kg, including 6 cases of hypertension, 7 cases of coronary heart disease, 10 cases of hyperlipidemia, 5 cases of sequelae of cerebral infarction. In general the two groups the difference was not statistically significant.2 blood coagulation function in two groups compared with that before treatment, treatment for first days, third days, two groups of patients with PT, APTT had no significant difference. For seventh days, fourteenth days, patients in the intervention group PT, APTT was significantly shorter than the control group (P0.05).3 two groups: before treatment, treatment for first days, third days was not statistically significant compared two groups of patients with platelet count difference. Treatment of 7,14. The pre group platelet count than the control group increased significantly (P0.05). There was statistical significance between the two groups before and after treatment in the same group the difference (F P0.05; F =60.262 in control group, intervention group =119.414, P0.05), treatment 7,14 days, two groups of platelet count were significantly higher than before treatment (P0.05) between.4 two group blood lactate levels: the two groups of patients with blood lactate levels before and after treatment, the difference was not statistically significant. Compared with the two groups before and after treatment the difference was statistically significant (=76.973 P0.05; F control group, F intervention group =82.004, P0.05), for first days, 3 days, 7 days, 14 days, two groups of patients with blood lactate levels were lower than that before treatment in two groups of.5 IL-1, TNF- alpha, IL-6 level compared with that before treatment, first days of treatment in two groups TN IL-1, F- alpha, IL-6 level had no significant difference. For third days, 7 days, 14 days, the intervention group of TNF- alpha, IL-1, IL-6 levels lower than the control group (P0.05). The intervention group before and after treatment were statistically significant (FTNF- alpha =104.952, P0.05; FIL-1=437.422, P0.05; FIL-6= 887.459, P0.05). Seventh days more than third days of TNF- alpha, IL-1, lower the level of IL-6, fourteenth days more than seventh days of TNF- alpha, IL-1, lower the level of IL-6 (P0.05).6 two group in the 14 day mortality rate comparison: the intervention group total mortality rate was slightly lower than the control group, but no significant differences between the two groups. Conclusion: 1 the blood will net injection can improve the coagulation function in septic patients (PT, APTT, platelet count shorten) may improve the.2 of Xuebijing injection in some extent could significantly decrease the serum levels of TNF-, IL-1, IL-6 expression level of.3 in Xuebijing injection can not improve the mortality in patients with septic shock.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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