血必净注射液在脓毒症早期集束化治疗中的作用

发布时间：2018-04-02 18:00

  本文选题：血必净注射液　切入点：脓毒症　出处：《广州中医药大学》2017年硕士论文

【摘要】：目的:本研究的主要目的在于观察中医证型为毒热内盛或瘀毒内阻证的脓毒症(Sepsis)患者在脓毒症早期集束化治疗中应用清热解毒、活血化瘀代表方药血必净注射液的治疗效果。通过对比治疗前后患者的序贯器官衰竭评分(SOFA评分)及降钙素原(PCT)的变化评价其治疗效果,以期进一步探讨中药复方制剂的临床疗效。方法:本研究为前瞻性随机对照研究,以2016年6月至2017年2月间广州中医药大学第一附属医院重症医学科收治的60例脓毒症患者为研究对象,按照随机数表法,将患者分为治疗组和对照组,每组各30例。两组患者均按照"2012年严重脓毒症和脓毒症休克治疗指南"治疗,治疗组在西医常规集束化治疗基础上加用血必净注射液50ml(0.9%氯化钠溶液配置至100ml),在患者收入ICU、确诊为脓毒症时即刻滴注一次,随后Q12H滴注一次,治疗时间为5天。对照组仅用西医常规集束化治疗。记录各患者治疗前、治疗后6h、24h及5天的SOFA评分及PCT数值。成果:1.治疗前两组患者的基本资料对比(性别、年龄、APACHE Ⅱ评分、SOFA评分、PCT数值),差异无统计学意义(P0.05),说明两组患者的数据具有可比性;2.治疗前后两组的组内对比,两组患者的SOFA评分、PCT数值均较治疗前有下降;治疗后6h、治疗后24h、治疗后5天与治疗前相比,差异存在显著统计学意义(P0.05)。说明在6h早期集束化治疗中和24h早期集束化治疗中,两种治疗方案能明显改善脓毒症患者炎症反应及器官功能衰竭的病情。3.治疗后两组的组间对比,治疗后6h、治疗后24h及治疗后5天,治疗组的SOFA评分和PCT数值均低于对照组,差异有统计学意义(P0.05),说明治疗组的疗效优于对照组。4.治疗前后两组的相关性分析,治疗前、治疗后6h、治疗后24h及治疗后5天,治疗组患者的SOFA评分与PCT数值具有显著相关性(P0.01);对照组患者的SOFA评分与PCT数值具有显著相关性(P0.01),说明SOFA评分与PCT数值评估疾病与药物疗效的效价相当。结论:无论是西医常规集束化治疗,还是集束化联合血必净注射液治疗,两种治疗方案均能够改善脓毒症患者的病情。与西医常规集束化治疗相比,在脓毒症早期集束化治疗中使用血必净注射液治疗,能更大程度的减轻机体炎性反应,减少多脏器衰竭风险,在一定程度上降低患者死亡率,改善疾病预后。在评估疾病严重程度方面,SOFA评分与PCT数值具有良好相关性,说明两者均属能准确评估血必净注射液疗效及脓毒症的病情变化,属于有效评估指标,值得在临床上进一步推广使用。
[Abstract]:Objective: the main purpose of this study was to observe the therapeutic effect of Sepsis of sepsis in the early stage of sepsis treated by clearing heat and detoxifying, activating blood circulation and removing blood stasis.The therapeutic effect was evaluated by comparing the changes of sequential organ failure score (sofa) and procalcitonin (PCT) before and after treatment in order to further explore the clinical efficacy of traditional Chinese medicine compound preparation.Methods: a prospective randomized controlled study was conducted in 60 sepsis patients admitted from the Department of intensive Medicine, the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, from June 2016 to February 2017.The patients were divided into treatment group and control group with 30 cases in each group.Both groups were treated in accordance with the 2012 guidelines for the treatment of severe sepsis and septic shock,The control group was only treated with conventional western medicine cluster therapy.SOFA scores and PCT values were recorded at 24 h and 5 days before and 6 hours after treatment.Result: 1.Before treatment, the basic data of the two groups were compared (sex, age, Apache 鈪，

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