【摘要】 目的分析医用臭氧自体血回输治疗对烧伤脓毒症相关性脑病患者血清炎性因子及脑多普勒血流灌注的影响,观察其临床疗效,初步探讨其治疗机制。方法回顾性收集2015-08-2019-05郑州市第一人民医院烧伤重症监护室接诊的90例烧伤并发脓毒性脑病患者的临床资料。随机分为对照组(46例)和治疗组(44例),2组基础用药为醒脑静,均连续治疗7 d,治疗组加用臭氧自体血回输治疗,1次/d,持续治疗7 d;对照组仅基础治疗。比较2组临床疗效,比较2组治疗前及治疗后第7天APACHE-Ⅱ评分、GCS评分变化,比较2组治疗前及治疗7 d后经颅多普勒血流变化值,第1、3、7天血清IL-1、IL-6、TNF-α、S100β水平。结果治疗7 d后治疗组的治疗效果显著优于对照组(χ2=3.951 4,P=0.046 8)。治疗前2组APACHE-Ⅱ评分(t=0.064 2,P=0.949 0)、GCS评分(t=1.879 9,P=0.063 4)无显著性差异;治疗后2组APACHE-Ⅱ评分(t=3.797 2,P=0.000 3)、GCS评分(t=4.934 2,P=0.000 1)均显著改善,治疗组APACHE-Ⅱ评分低于对照组,GCS评分高于对照组。经颅多普勒血流变化值,2组治疗前双侧大脑中动脉平均血流速度(t=0.228 9,P=0.819 5)、收缩期血流速度(t=0.223 2,P=0.823 9)、舒张期血流速度(t=1.868 2,P=0.065 1)、搏动指数(t=1.144 1,P=0.255 7)、脑血流指数(t=0.745 7,P=0.457 8)及平均动脉压(t=1.868 2,P=0.065 1)比较,差异均无统计学意义;治疗7 d后2组双侧大脑中动脉平均血流速度(t=3.933 6,P=0.000 2)、收缩期血流速度(t=2.001 0,P=0.048 6)、舒张期血流速度(t=3.469 9,P=0.000 1)、脑血流指数(t=4.352 2,P=0.000 1)及平均动脉压(t=2.208 1,P=0.029 8)均上升,搏动指数(t=3.427 7,P=0.000 1)均下降,且治疗组与对照组相比差异有统计学意义。治疗前血清炎症指标IL-1(t=0.870 7,P=0.386 3)、IL-6(t=0.506 9,P=0.613 5)、TNF-α(t=0.850 4,P=0.395 6)、S100β(t=0.472 9,P=0.637 4)比较差异无统计学意义,治疗7 d后均降低;治疗组IL-1(t=11.426 3,P=0.000 1)、IL-6(t=14.112 6,P=0.000 1)、TNF-α(t=11.781 2,P=0.000 1)、S100β(t=5.223 9,P=0.000 1)下降程度优于对照组。2组均未发生严重不良反应。结论医用臭氧自体血治疗可有效改善烧伤脓毒性脑病患者临床症状,稳定各项生命体征,纠正患者脑部血流灌注不足,降低患者血清炎症因子IL-1β、TNF-α、S100β水平,临床效果可靠。更多还原

【Abstract】 Objective To study the clinical effect of ozone autotransfusion treatment of burn sepsis-related encephalopathy and its effect on serum inflammatory factors,and to explore its mechanism of action in the treatment of burn sepsis-related encephalopathy.Methods A retrospective study was conducted on 90 patients with burn complicated with septic encephalopathy admitted to the burn intensive care unit of our hospital from August 2015 to May 2019.According to different clinical treatment methods,they were divided into treatment group(n=44) and control group(n=46).Both groups were treated continuously with Xingnaojing for 7 days,in addition to basic treatment,the treatment group was treated with ozone autotransfusion once a day,seven days a course.The control group used only basic treatment.According to the GCS score,we compared the effective rate after treatment,APACHE-Ⅱ score and GCS score before and on the 7 th day after treatment,the change of blood perfusion by transcranial Doppler before and on the 7 th day after treatment,and serum IL-1,IL-6,TNF-α and S100β levels on the 1 st,3 rd and 7 th day in the two groups.Results There was a significant difference between the two groups in the proportion of recovery,effective and effective after 7 days of treatment.The treatment effect of the treatment group was better than the control group(χ~2=3.951 4,P=0.046 8),There was no significant difference in APACHE-Ⅱscore(t=0.064 2,P=0.949 0) and GCS score(t=1.879 9,P=0.063 4) between the two groups before treatment.The APACHE-Ⅱ score(t=3.797 2,P=0.000 3) and GCS score(t=4.934 2,P=0.000 1) of the two groups were significantly improved after treatment.The patients in the treatment group scored lower than the control group,the GCS score was higher than the control group.There was no significant difference in VsMCA(t=0.223 2,P=0.823 9),VdMCA(t=1.868 2,P=0.065 1),VmMCA(t=0.228 9,P=0.819 5),PI(t=1.144 1,P=0.255 7),CBFi(t=0.745 7,P=0.457 8),MAP(t=1.868 2,P=0.065 1) between the two groups before treatment.After 7 days of treatment,the two groups were significantly lower than those of the control group.There was no statistical significance in the serum inflammatory indexes of IL-1(t=0.870 7,P=0.386 3),IL-6(t=0.506 9,P=0.613 5),TNF-α(t=0.850 4,P=0.395 6),S100β(t=0.472 9,P=0.637 4) before treatment.After 7 d of treatment,the reduction of IL-1(t=11.426 3,P=0.000 1),IL-6(t=14.112 6,P=0.000 1),TNF-α(t=11.781 2,P=0·000 1) and S100β(t=5.223 9,P=0.000 1) in the treatment group were better than those in the control group.No serious adverse reactions occurred in two groups.Conclusion Medical ozone self-blood treatment can reduce the APACHE-Ⅱ score of patients with burn septic encephalopathy,improve the mental symptoms of patients,stabilize various vital signs,effectively reduce the level IL-1,TNF-α,S100(3 serum inflammatory factors in patients with burn septic encephalopathy,which has a more reliable clinical effect.更多还原