血必净注射液联合抗生素治疗急性盆腔腹膜炎的临床观察和实验研究

发布时间：2018-05-29 04:24

本文选题：急性盆腔腹膜炎 + 血必净注射液　；参考：《湖北中医药大学》2014年硕士论文

【摘要】：目的：本文采用临床观察及实验研究相结合的方法,以探讨血必净注射液联合抗生素治疗急性盆腔腹膜炎的可行性及其优势。临床上,应用血必净注射液联合仙力素来治疗急性盆腔腹膜炎,并与单独使用抗生素疗法相比较,对比两种方法对中医症状疗效、临床综合疗效的影响。实验方面,通过研究血必净注射液对脓毒症大鼠血中降钙素原(PCT)、白介素-6(IL-6)mRNA表达的影响,探讨血必净注射液联合抗生素治疗急性盆腹腔感染的可能机制,以及单独应用血必净注射液治疗急性盆腹腔感染的可行性,为临床上血必净注射液用于治疗急性盆腔腹膜炎提供理论依据。方法：临床研究方面,选取70例符合急性盆腔腹膜炎中、西医诊断标准的患者作为研究对象,将研究对象随机分为治疗组和对照组各35例。对照组35例仅予抗生素治疗,即：仙力素1.5g加入0.9%氯化钠溶液250m1静滴,每天1次。治疗组35例患者在对照组抗生素治疗的基础上,加用50ml血必净注射液稀释于1OOm1的生理盐水中,30分钟内滴完,每天2次。两组患者观察时间均为3天,随访1月。观察过程中不得使用其他功能相似的药物。比较两组用药前后中医症状疗效、临床综合疗效及不良反应,并进行统计学分析。实验研究方面,将40只成年SD大鼠,随机分为血必净组(血必净8ml/kg+0.9%氯化钠注射液8ml/kg)、抗生素组(仙力素200mg/kg+0.9%氯化钠注射液8ml/kg)、联合用药组(仙力素200mg/kg+血必净8ml/kg)和对照组(0.9%氯化钠注射液16ml/kg),每组10只。采用盲肠结扎穿孔术建立脓毒症大鼠模型,分别在术前1小时和术后2、6、10、16、28小时用内外眦静脉采血、舌下静脉采血以及腹主动脉抽取大鼠血500μ1,采用荧光定量PCR (RT-PCR)法检测大鼠血中PCT和IL-6的mRNA表达。结果：临床研究：治疗组有33例获得随访,对照组共34例获得随访。1.中医症状疗效：治疗组与对照组两种用药方案治疗急性盆腔腹膜炎,中医症状总积分均有改善。治疗组治疗后各个症状均有明显改善(P0.05)对照组经治疗后头痛、恶心、食少、腹痛、腹胀、腹泻症状较治疗前有明显改善(P0.05),而发热、恶寒、咳嗽、月经量多、经期延长、白带量多等中医症状积分虽较治疗前降低,但差异无统计学意义(P0.05)。治疗后两组间相比,头痛、恶心、食少、腹胀、腹痛、腹泻症状改善无统计学意义(P0.05),其余症状改善治疗组优于对照组(P0.05)。就中医症状总积分而言,治疗组的中医症状总疗效明显优于对照组。2.临床综合疗效：治疗组与对照组治疗后临床综合疗效比较,治疗组治愈率为48.48%,明显高于对照组治愈率23.53%,经比较两组间差异有统计学意义(P0.05),而两组间总有效率的差异无统计学意义(P0.05)。3.炎症指标：治疗后两组白细胞总数、C反应蛋白、降钙素原、白介素-6的差异有统计学意义(P0.05)。4.安全性评价：治疗组与对照组在治疗期间和随访调查中均未出现明显不良反应,安全性较高。实验研究：1.脓毒症大鼠血中IL-6的mRNA的表达较正常明显升高,此时若给予血必净注射液联合抗生素治疗,可以使其表达在短时间内迅速恢复正常；而单独运用血必净注射液或单独使用抗生素治疗脓毒症大鼠,其血IL-6的mRNA的表达也可逐渐恢复,但恢复时间较联合用药长。2.脓毒症大鼠血中PCT的mRNA的表达较正常明显升高,此时若给予血必净注射液联合抗生素治疗,可以使其表达在短时间内迅速恢复正常；而单独运用血必净注射液或单独使用抗生素治疗脓毒症大鼠,其血PCT的mRNA的表达也可逐渐恢复,但恢复时间较联合用药长。结论： 1.对于急性盆腔腹膜炎的患者采用血必净注射液联合抗生素治疗,与传统单纯运用抗生素治疗相比,此疗法在中医症状疗效方面具有明显优势,临床疗效肯定,患者炎症指标恢复更好,值得在临床运用中进一步推广。 2.就目前少数病例而言,血必净注射液用于治疗急性盆腔腹膜炎,在用药期间及用药后均未发现不良反应,安全性较高。 3.血必净注射液用于治疗急性盆腔腹膜炎,可能与其降低血清PCT、 IL-6的mRNA表达,抑制机体炎性反应作用有关。 4.就目前动物实验来说,单独应用血必净注射液治疗急性盆腹腔感染具有一定的可行性,临床上可以通过大样本临床试验对此结论进行考证。
[Abstract]:Purpose :

In this paper , the effect of Xuebijing injection in the treatment of acute pelvic peritonitis was studied by means of the combination of clinical observation and experimental study . The effect of Xuebijing injection on the expression of calcitonin ( PCT ) and interleukin - 6 ( IL - 6 ) mRNA in acute pelvic peritonitis was studied .

Method :

In clinical research , 70 patients with acute pelvic peritonitis and western medicine were randomly divided into treatment group and control group .

In the experimental study , 40 adult SD rats were randomly divided into Xuebijing group ( Xuebijing 8ml / kg + 0.9 % sodium chloride injection 8ml / kg ) , antibiotic group ( Androgen 200mg / kg + 0.9 % sodium chloride injection 8ml / kg ) and control group ( 0.9 % sodium chloride injection 16ml / kg ) .

Results :

In the treatment group , there was no significant difference between treatment group and control group ( P0.05 ) . There was no significant difference between treatment group and control group ( P0.05 ) .

Experimental study : 1 . The expression of IL - 6 mRNA in blood of septic rats was higher than that of normal rats .
However , the expression of PCT mRNA in the blood of septic rats was significantly higher than that of the combined therapy .
However , using Xuebijing injection alone or using antibiotics alone in the treatment of septic rats , the expression of PCT mRNA in blood can be gradually recovered , but the recovery time is longer than the combined use .

Conclusion :

1 . For patients with acute pelvic peritonitis treated with Xuebijing injection combined with antibiotics , compared with traditional simple antibiotic therapy , this therapy has obvious advantages in the treatment of symptoms of traditional Chinese medicine , the clinical curative effect is positive , the recovery of inflammatory index of the patient is better , and it is worth further popularization in clinical application .

2 . As far as few cases are concerned , Xuebijing injection is used for the treatment of acute pelvic peritonitis , no adverse reaction is found during and after administration , and the safety is high .

3 . Xuebijing injection can be used for the treatment of acute pelvic peritonitis , which may reduce the expression of PCT and IL - 6 mRNA in serum and inhibit the inflammatory response of the body .

4 . For the present animal experiment , it is feasible to apply Xuebijing Injection alone in the treatment of acute pelvic abdominal infection .
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R711.3

【参考文献】