“菌毒炎并治”对脓毒症患者的临床疗效和部分血清学指标影响

发布时间：2018-01-28 06:53

  本文关键词： 脓毒症 菌毒炎并治 凉膈散 血必净注射液 临床疗效　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本课题旨在观察脓毒症患者的生命体征、炎症反应参数、凝血功能指标、APACHEII评分、中医症状评分、胃肠功能障碍发生率、14及28天生存率等作为临床疗效评价指标,对照观察“菌毒炎并治”的治疗方案对脓毒症患者的临床疗效,为脓毒症治疗方案的进一步优化提供有益的帮助。方法:采用前瞻性、随机、对照的实验设计方法,选取2014年3月至2015年7月符合纳入标准的患者50例,利用随机数字表法将患者随机划分为治疗组和对照组。对照组给予一般西医基础治疗(参照《2012年国际脓毒症及脓毒症休克治疗指南》,包括早期广谱抗生素、液体复苏、预防应激性溃疡、控制血糖、脏器支持和基础病因治疗等)和血必净注射液50ml,静脉点滴,每日2次,疗程7天。治疗组在对照组治疗基础之上加用凉膈散颗粒剂150ml,口服或鼻饲,每日2次,疗程7天。于入组当天、给药后第3天、第7天或死亡前,分别观察患者相关症状体征,检测血常规、血气分析、凝血全项、C反应蛋白、降钙素原、TNF-a、IL-1β、IL-10并进行APACHE-II评分、DIC评分,随访14天、28天生存率。结果:1在炎症反应指标方面,治疗组的体温降低幅度相对于对照组更为明显,差异具有统计学意义(P0.05),治疗组WBC、PCT、TNF-a水平较对照组比较明显下降(P0.05),而治疗组IL-10水平较治疗前明显升高(P0.05)。2在凝血功能指标方面,治疗组APTT未见明显延长,对照组治疗第7天APTT较治疗前明显延长,差异有统计学意义(P0.05);治疗组治疗第3天D-二聚体水平明显降低,与对照组比较差异具有统计学意义(P0.05);治疗组第7天PLT明显升高,与对照组比较差异具有统计学意义(P0.05);治疗组第7d天DIC评分比治疗前下降,和对照组相比差异显著,体现出统计学意义(P0.05)。3对照组和治疗组APECHE-II评分与治疗前比较均有所下降,治疗组第7天较治疗前下降明显,差异有统计学意义(P0.05);经治疗两组患者第3、7天中医症候积分均较治疗前显著下降(P0.01),治疗组患者第7天中医症候积分相对于对照组显著下降,差异体现统计学意义(P0.01);两组比较综合疗效,对照组与治疗组有效率分别为20%和60%;两组比较有效率,治疗组明显高于对照组,差异体现统计学意义(P0.05)。4对照组与治疗组第14天死亡率分别为24%和16%,28天死亡率分别为32%和24%,两组比较差异亦无统计学意义(P0.05)。结论:“菌毒炎并治”治疗方案对降低高热脓毒症患者体温更有效,降低WBC、PCT、CRP水平,能够更好的降低患者体内TNF-a的浓度,从源头上抑制“炎症瀑布反应”的发生,能够促进IL-10的释放,抑制炎症介质的产生,从而来调节促炎和抗炎反应的动态平衡,有助于全身炎症反应的控制。该治疗方案还能够改善部分凝血功能指标,阻断脓毒症继发性纤溶亢进和纤维蛋白原的消耗,改善脓毒症凝血功能障碍,促进脓毒症患者病情好转,在一定程度上改善患者预后,值得临床推广应用。
[Abstract]:Objective: to observe the vital signs, inflammatory parameters, coagulation function index and Apache II score, TCM symptom score and incidence rate of gastrointestinal dysfunction in patients with sepsis. The 14 and 28 days survival rate was used as the clinical curative effect evaluation index, the clinical curative effect of "Bacteritis combined with treatment" in patients with sepsis was observed. Methods: prospective, randomized and controlled experimental design was used. From March 2014 to July 2015, 50 patients who met the inclusion criteria were selected. Patients were randomly divided into treatment group and control group by random digital table. The control group was given general western medicine basic treatment (reference < 2012 International guidelines for treatment of sepsis and sepsis shock). These include early broad-spectrum antibiotics, fluid resuscitation, prevention of stress ulcers, control of blood glucose, organ support and basic etiology therapy) and Xuebijing injection 50 ml, intravenous drip twice a day. The treatment group was treated with Liangge Powder (150ml), orally or by nasal feeding, twice a day for 7 days. On the day of treatment, on the third day, the 7th day or before death, the treatment group was treated with Liangge Powder in addition to the control group. The symptoms and signs of the patients were observed, blood routine examination, blood gas analysis, blood clotting all of C reactive protein, procalcitonin TNF-a IL-1 尾 were observed. IL-10 was followed up with APACHE-II score and the survival rate was 28 days after 14 days follow-up. Results: 1 was involved in inflammatory response index. The decrease of body temperature in the treatment group was more obvious than that in the control group, and the difference was statistically significant (P 0.05). The level of TNF-a was significantly lower than that of the control group (P 0.05), while the level of IL-10 in the treatment group was significantly higher than that before treatment. The APTT of the treatment group was not significantly prolonged, and the APTT of the control group was significantly longer on the 7th day than that before treatment (P 0.05). On the 3rd day of treatment, the level of D- dimer in the treatment group was significantly lower than that in the control group (P 0.05). On the 7th day, the PLT in the treatment group was significantly higher than that in the control group (P 0.05). On the 7th day, the DIC score of the treatment group was lower than that of the control group, and there was a significant difference between the treatment group and the control group. The APECHE-II scores of the control group and the treatment group were lower than that of before treatment, and the APECHE-II score of the treatment group on the 7th day was significantly lower than that before treatment. The difference was statistically significant (P 0.05). The scores of TCM symptoms on the 3rd day after treatment were significantly lower than those before treatment, and the scores of TCM symptoms on the 7th day in the treatment group were significantly lower than those in the control group. The difference was statistically significant (P 0.01). The effective rates of control group and treatment group were 20% and 60 respectively. The effective rate of the two groups was significantly higher than that of the control group, the difference was statistically significant (P 0.05). 4 the mortality of the control group and the treatment group on the 14th day were 24% and 16% respectively. The death rates of 28 days were 32% and 24, respectively, and there was no significant difference between the two groups (P 0.05). Conclusion: the treatment of "Bacteritis combined with treatment" is more effective in reducing the body temperature of patients with hyperpyretic sepsis. Reducing the level of TNF-a in patients can reduce the concentration of TNF-a, inhibit the occurrence of "inflammatory waterfall" from the source, and promote the release of IL-10. Inhibit the production of inflammatory mediators, thereby regulating the dynamic balance of pro-inflammatory and anti-inflammatory response, which is helpful to the control of systemic inflammatory response. Blocking the secondary hyperfibrinolysis and the consumption of fibrinogen in sepsis, improving the coagulation dysfunction of sepsis, promoting the improvement of the condition of sepsis, improving the prognosis of the patients to a certain extent, is worthy of clinical application.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R459.7
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本文编号：1470091