血必净在严重外伤并发多器官功能障碍综合征应用中的评价

发布时间：2018-01-26 10:30

本文关键词： 严重创伤多器官功能障碍综合征血必净　出处：《大连医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：目前采用多种手段对MODS进行治疗，，虽然取得了一定进展，但至今仍有较高的死亡率，治疗费用高昂，其根本原因在于现阶段无法有效抑制MODS病理发展过程，虽然采用各种先进方法使患者生命得到延长，但愈后改变不尽人意，病死率居高不下，且病死率随功能衰竭器官的数目增加而增加，因此，探索更为有效的防治手段以改善该种病人的预后和生活质量已经成为危重病领域重点研究课题。MODS患者的微循环障碍、血液瘀滞、血流不畅等是其重要的病理生理变化，为中医药活血化瘀法治疗MODS提供了主要依据。本研究通过观察血必净治疗组与对照组病人临床转归情况，明确血必净注射液是否可以缩短并发多器官功能障碍综合征患者的病程、改善相关症状、防止已经受累的器官功能障碍进一步加重，保护尚未受累及的器官，以及是否有明显的毒副作用。为临床治疗严重外伤并发多器官功能障碍综合征提供有益的借鉴。方法：采用多中心、随机、平行对照分组方法，对由严重创伤导致的多器官功能障碍综合征病例进行观察。治疗组和对照组均选择针对患者最佳的个体化治疗方案，确保患者的安全，并不会因临床研究而加重对患者身体的损害。治疗组在个体化治疗基础上加血必净注射液，观察治疗后患者的反应，观察指标选择在MODS中最易受累及的循环、呼吸、血液系统。循环方面的功能：观察血必净治疗后平均动脉压、尿量是否增加，心率是否下降，与对照组比较是否有统计学意义；呼吸方面的功能：观察氧合指数是否升高，呼吸频率是否下降，与对照组比较是否有统计学意义；血液方面：观察血小板是否升高，与对照组比较是否有统计学意义；综合方面：受累器官评分是否增加，与对照组比较是否有统计学意义。结果：按临床控制、显效、无效、死亡进行评定。血必净注射液治疗组控显率达到88.46％，对照组控显率为70.83％，两组经统计学比较，有显著性差异，P0.05。结论：血必净注射液可以辅助治疗由多发创伤等引起的多器官功能障碍综合征，在呼吸、循环及凝血方面较对照组有明显改善，提高平均动脉压、增加尿量、改善氧合、改善凝血，缩短病程，改善相关症状，防止受累器官功能障碍进一步加重，保护未受累的器官。临床试验中未发现明显的毒副作用。
[Abstract]:Objective: although some progress has been made in the treatment of MODS by various methods, there is still a high mortality rate and the cost of treatment is high. The fundamental reason lies in the fact that the pathological development of MODS can not be effectively inhibited at this stage. Although various advanced methods are used to prolong the life of patients, the changes after recovery are unsatisfactory and the fatality rate remains high. The mortality increased with the increase of the number of organs of functional failure. To explore more effective prevention and treatment methods to improve the prognosis and quality of life of this kind of patients has become a critical research topic in the field of critical diseases .mods patients with microcirculation disorders, blood stasis. Blood flow obstruction is an important pathophysiological change, which provides the main basis for the treatment of MODS by activating blood circulation and removing blood stasis. By observing the clinical outcome of patients in Xuebijing treatment group and control group, it is clear whether Xuebijing injection can shorten the course of disease and improve the related symptoms in patients with multiple organ dysfunction syndrome. To prevent the dysfunction of the affected organs from becoming more serious and to protect the unaffected organs. And whether there are obvious side effects. It provides a useful reference for the clinical treatment of severe trauma complicated with multiple organ dysfunction syndrome. Methods: a multicenter, randomized, parallel control group was used. The patients with multiple organ dysfunction syndrome caused by severe trauma were observed. Both the treatment group and the control group chose the best individualized treatment for patients to ensure the safety of patients. Treatment group on the basis of individualized treatment plus Xuebijing injection to observe the response of patients after treatment. The function of circulation, respiration and blood system in MODS: observe the mean arterial pressure, urine volume and heart rate after Xuebijing treatment. Compared with the control group, there was statistical significance. Respiratory function: observe whether oxygenation index is increased, respiratory frequency is decreased, compared with the control group, whether there is statistical significance; Blood: observe whether the platelet is elevated, compared with the control group, whether there is statistical significance; Comprehensive aspects: whether the score of affected organs increased, and whether there was statistical significance compared with the control group. Results: according to clinical control, remarkable effect, ineffective, death evaluation. Xuebijing injection treatment group control rate reached 88.46 and the control group control rate was 70.83, the two groups were compared statistically. There was significant difference (P 0.05). Conclusion: Xuebijing injection can be used to treat multiple organ dysfunction syndrome caused by multiple trauma. Compared with the control group, Xuebijing injection can improve respiration, circulation and coagulation, increase mean arterial pressure and increase urine volume. It can improve oxygenation, improve coagulation, shorten the course of disease, improve the related symptoms, prevent the dysfunction of the involved organs from further aggravation, and protect the unaffected organs. No obvious toxic side effects were found in the clinical trials.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

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