血毒清对脓毒症凝血指标影响的临床研究

发布时间：2018-10-23 13:13

【摘要】：1目的通过对脓毒症患者应用安徽中医药大学第一附属医院周大勇导师经验中药复方血毒清进行临床实验,观察脓毒症患者凝血系统紊乱,研究其对各项凝血指标的影响,观察患者治疗前后的炎症因子、凝血指标、各类预后转归评分等多方面指标探讨血毒清对脓毒症患者凝血功能影响的干预效果。2方法将2015年07月至2017年01月在安徽中医药大学第一附属医院综合ICU确诊的60例脓毒症患者,采用卡西欧fx-180函数计算器产生随机数字进行简单随机化分组,分为对照组和治疗组。对照组西医诊治参照2014年由中华医学会重症医学分会制定的中国严重脓毒症/脓毒性休克治疗指南,主要包括原发疾病的治疗(如控制感染灶)、控制血糖、免疫调理、液体复苏、脏器功能保护与支持(呼吸机的应用、稳定机体循环功能、肾脏替代治疗等)。对照组中医诊断参照2007年中国中西医结合学会急救医学及中华医学会急诊医学分会危重病专家委员会共同制订的脓毒症的定义、诊断标准、中医证候诊断要点及说明。治疗组在常规治疗方案基础上加用安徽中医药大学第一附属医院周大勇导师经验中药复方血毒清水煎后鼻饲患者,每日100ml,每日2次,一疗程为期5天。所有使用的中药均来自于安徽中医药大学第一附属医院,并由本院煎药室煎制而成,一剂一袋,每袋100ml。比较两组患者治疗前后的白细胞计数(WBC)、中性粒细胞计数(NEUT)、降钙素原(PCT)、C反应蛋白(CRP)、乳酸(LAC)、血小板计数(PLT)、D-二聚体(D-D)、凝血酶时间(TT)、凝血酶原时间(PT)、部分凝血酶原时间(APTT)、APACHE II评分值、SOFA评分值、中医症候积分、中医疗效判定等。3结果(1)两组患者治疗后的WBC、NEUT均有下降(P0.05),治疗组WBC、NEUT下降更明显,具有比较意义(P0.05)。(2)两组治疗后的PCT、LAC均有下降(P0.05),治疗组PCT、LAC下降更明显,具有比较意义(P0.05)。(3)两组治疗后的CRP均有降低(P0.05),但治疗组间CRP相比较,无统计学差异(P0.05)。(4)两组治疗后的PLT、D-D均有改善(P0.05),治疗组PLT、D-D改善更明显,具有统计学差异(P0.05)。(5)两组治疗后的PT、APTT、TT均有降低(P0.05),治疗组PT、APTT、TT下降更明显(P0.05)。(6)两组治疗后APACHEII评分值、SOFA评分值、中医证候评分降低(P0.05),治疗组评分下降更低(P0.05)。(7)对照组临床控制10例,无效8例,显效7例,有效5例,总体有效率73.33%,治疗组临床控制15例,无效3例,显效8例,有效4例,总体有效率90%,两组差异有统计学意义(P0.05)。4结论血毒清能降低脓毒症患者的WBC、NEUT、PCT、LAC水平,促进患者炎症反应的修复;血毒清能改善脓毒症患者的PLT、D-D、PT、APTT、TT水平,促进患者凝血功能的修复;血毒清能降低患者的APACHE II评分值、SOFA评分值和中医证候积分值,在改善患者的临床表现和预后方面起到了一定的作用。
[Abstract]:Objective to observe the disorder of coagulation system in patients with sepsis by using the experience of tutor Zhou Dayong of the first affiliated Hospital of Anhui University of traditional Chinese Medicine to observe the disorder of coagulation system and to study the effect of the disorder of coagulation system on the indexes of coagulation. The inflammatory factors and coagulation indexes before and after treatment were observed. To explore the intervention effect of Xueduqing on coagulation function of sepsis patients. 2 60 patients with sepsis diagnosed by ICU from July 2015 to January 2017 in the first affiliated Hospital of Anhui University of traditional Chinese Medicine were studied. Casio fx-180 function calculator was used to generate random numbers and divided into control group and treatment group. The treatment of western medicine in the control group refers to the guidelines for the treatment of severe sepsis / septic shock in China developed in 2014 by the Chinese Medical Association for severe sepsis / septic shock, mainly including the treatment of primary diseases (such as controlling infected foci), controlling blood sugar, and regulating immunity. Fluid resuscitation, organ function protection and support (application of ventilator, stabilization of circulatory function, renal replacement therapy, etc.) In the control group, the definition of sepsis, the diagnostic criteria, the main points of TCM syndrome diagnosis and the explanation were drawn up by the Emergency Medicine expert Committee of the Chinese Association of Emergency Medicine and the Emergency Medicine Committee of the Chinese Society of Integrated Chinese and Western Medicine in 2007. On the basis of routine treatment, the treatment group was treated with tutors of Zhou Dayong, the first affiliated Hospital of Anhui University of traditional Chinese Medicine, after nasal feeding with Xueduqing decoction, 100 ml per day, twice a day, for 5 days. All the Chinese medicines used are from the first affiliated Hospital of Anhui University of traditional Chinese Medicine, and are made from the decoction room of this hospital, one dose a bag, each bag 100 ml. (WBC), neutrophil counts were compared between the two groups before and after treatment. (NEUT), procalcitonin (PCT), C reactive protein (CRP), lactate (LAC), platelet count (PLT), D- dimer (D-D), thrombin time (TT), prothrombin time (PT), partial prothrombin time (APTT), APACHE II score, SOFA score, Results: (1) the WBC,NEUT of the two groups decreased after treatment (P0.05), the WBC,NEUT of the treatment group decreased more significantly (P0.05). (2), the PCT,LAC of the two groups decreased after treatment (P0.05), the PCT,LAC of the treatment group decreased more obviously. There was significant difference (P0.05). (3) in CRP between the two groups after treatment (P0.05), but there was no significant difference in CRP between the two groups (P0.05). (4). The improvement of PLT,D-D in the treatment group was more obvious than that in the treatment group (P0.05). There was significant difference (P0.05). (5) between the two groups after treatment of PT,APTT,TT (P0.05), the treatment group PT,APTT,TT decreased more significantly (P0.05). (6) two groups after the treatment of APACHEII score, SOFA score, TCM syndrome score decreased (P0.05), the treatment group score decreased even lower (P0.05). (7) control group 10 cases of clinical control, The total effective rate was 73.33. In the treatment group, there were 15 cases of clinical control, 3 cases of failure, 8 cases of remarkable effect and 4 cases of effective. The total effective rate was 90, the difference between the two groups was statistically significant (P0.05). 4 conclusion Xueduqing can reduce the level of WBC,NEUT,PCT,LAC and promote the repair of inflammatory reaction in patients with sepsis, Xueduqing can improve the level of PLT,D-D,PT,APTT,TT in patients with sepsis and promote the repair of coagulation function of patients. Xueduqing can reduce the APACHE II score, SOFA score and TCM syndrome score, which plays a certain role in improving the clinical manifestations and prognosis of patients.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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