【作者】 马宁；

【导师】 孙荣青；

【作者基本信息】 郑州大学 ， 急诊医学， 2012， 硕士

【摘要】 目的通过检测脓毒症患者血浆中IL-18、PCT、CRP浓度及APACHE Ⅱ评分来评估不同剂量血必净治疗脓毒症的疗效。方法选取2010年8月至2011年6月郑州大学第一附属医院重症监护病房(ICU)内住院满14天的患者,其中符合2001年美国胸科医师学会／危重病学会(ACCP/SCCM)在美国华盛顿联席会议脓毒症诊断标准的共68例,检测资料完整的患者共63例。采用随机信封法将其分为四组：对照组19例(A组)和低剂量组20例(B组,血必净注射液100ml/天)、中等剂量组14例(C组,血必净注射液200ml/天)、高剂量组10例(D组,血必净注射液400ml/天),四组均采用常规西医治疗方法(包括病因治疗、抗生素、呼吸机支持、补液、营养支持、维持电解质平衡等),低剂量、中剂量及高剂量组在此基础上加用血必净注射液；记录患者用药前(X0)及用药后3天(X3)、7天(X7)、14天(X14),四个时间点的生命体征(包括体温、呼吸、脉搏、血压)、血常规、肝功能、肾功能、电解质、凝血功能、白细胞介索-18(IL-18)、前降钙素原(PCT)、C-反应蛋白(CRP)及急性生理和慢性健康评分(APACHE Ⅱ评分),同时取静脉血3ml,离心后将血清置于1.5ml离心管(EP管)内保存在-70℃低温冰箱里,用ELISA试剂盒检测四个时间点血清中IL-18浓度；同时记录每个患者14天生存情况。最后应用SPSS17.0统计其治疗前及治疗后不同剂量血必净在治疗脓毒症方面是否有统计学差异。结果1、治疗前,四组患者的年龄、性别、生命体征(包括体温、呼吸、心率、血压)、血常规、肝功能、肾功能、电解质、凝血功能、IL-18、PCT、CRP及APACHE Ⅱ评分的差异无统计学意义(P>0.05)。2、对照组(A组)：按常规西医方法治疗后的生命体征(包括体温、呼吸、心率、血压)、血常规、肝功能、肾功能、电解质及凝血功能在用药后第14天,差异性有统计学意义(P<0.05)：炎症因子(IL-18、PCT、CRP)及APACHE Ⅱ评分在治疗后第7天P<0.05,差异性有统计学意义；3、低剂量组、中剂量组及高剂量组：应用血必净治疗后较对照组比较生命体征(包括体温、呼吸、心率、血压)、血常规、肝功能、肾功能、电解质及凝血功能有显著改变(P<0.05),其改变程度与剂量呈负相关性；4、低剂量组(B组)：在治疗后炎症因子(IL-18、PCT、CRP)及APACHEⅡ评分比较第7天P<0.05,差异显著,有统计学意义,治疗后第14天P<0.01,差异非常显著,有统计学意义,组间比较可见,低剂量组于用药后第14天与对照组比较P<0.05,差异显著,有统计学意义；5、中剂量组(C组)：在治疗后炎症因子(IL-18、PCT、CRP)及APACHEⅡ评分比较第3天P<0.05,差异显著,有统计学意义,治疗14天后P<0.01,差异显著,有统计学意义,组间比较可见,中剂量组于用药后第3天与低剂量组P<0.05,差异显著,有统计学意义,用药后第14天与低剂量组比较P<0.01,差异非常显著,有统计学意义；6、高剂量组(D组)：在治疗后炎症因子(IL-18、PCT、CRP)及APACHEⅡ评分比较第3天P<0.05,差异显著,治疗后第7天P<0.01,差异非常显著,有统计学意义,组间比较可见,高剂量组于用药后第3天与中剂量组P<0.05,差异显著,用药后第7天P<0.01,差异非常显著,有统计学意义；7、对照组、低剂量组、中剂量组及高剂量组14天累计生存率经Kaplan-Meier方法分析显示：四组脓毒症患者的累计生存率随观察时间的延长逐渐升高。结论脓毒症早期应用大剂量血必净注射液有助于改善患者体温、心率及白细胞水平；调节微循环及氧代谢障碍,调控机体炎症反应阻断SIRS转向MODS的发展；保护多脏器功能及改善凝血,同时提高脓毒症患者14天累计生存率。更多还原

【Abstract】 ObjectiveTo evaluate different doses Xuebijing injection through testing IL-18, PCT, CRP levels and APACHE Ⅱ scoring of the septic patients after treatment.Methods68hospitaled patients were selected who were hospitaled intensie care unit (ICU) over14days in August2010to June2011in the First Affiliated Hospital of Zhengzhou University and consistenting with diagnostic criteria of the2001American College of Chest Physicians/Socirty of Critical Care Medicine(ACCP/SCCM) joint meeting in Washington, DC, finally63patients materials were completed. Our patients were divided into four groups using random method which is:control group contained19cases (Group A), low dose group20cases(Group B, Xuebijing injection100ml/day), medium dose group14cases(Group C,Xuebijing injection200ml/day), high dose group10cases(Group D,Xuebijing injection400ml/day). Patients of were all treated with conventional Western treatment which including pathogeny cure, antibiotics, ventilator support, rehydration, nutrition support, maintain electrolyte balance, etc, patients of low dose group, medium dose group and high dose group were injection xuebijing injection additional. Our patients’ vital signs (including body temperature, breathing, pulse and blood pressure). blood routine and liver function, kidney function, electrolyte, coagulation function, IL-18, PCT, CRP and APACHE Ⅱ score) were recorded before treatment (XO) and after3days (X3),7days (X7),14days (X14) after xuebijing injection. At the previous four points, we taken3ml venous blood, placed in1.5ml EP stored in-70℃refrigerator after centrifugal, detected the serum IL-18concentration with ELISA test. At the same time recorded the condition of every patients in14days. Finally the different effection before and after the treatment with on sepsis with Xuebijing was statisticed through SPSS17.0.Results1. Age, gender, vital signs (including body temperature, breathing, pulse and blood pressure), blood routine and liver function, kidney function, electrolyte, coagulation function, IL-18, PCT,CRP and APACHE Ⅱ score of four group have no statistical significance (P>0.05).2. control group (Group A):Vital signs (including body temperature, breathing, pulse and blood pressure), blood routine and liver function, kidney function, electrolyte, coagulation function which through conventional western medicine treatment method after14days were statistical significance (P<0.05), inflammatory factor (IL-18, PCT, CRP) and APACHE Ⅱ score after treatment7days were statistical significance (P<0.05).3. Low dose group, medium dose group and high dose group:The change of vital signs (including body temperature, breathing, pulse and blood pressure), blood routine and liver function, kidney function, electrolyte, coagulation function degress and dose is negative correlation, have statistical significance (P<0.05).4.Low dose group:Inflammatory factor (IL-18, PCT,CRP)and APACHE II score are treating after7days, have statistical significance (P<0.05), after14days which have statistical significance (P<0.01). Comparison among groups, low dose group compares with control group after14days which have statistical significance (P<0.05).5.Medium dose group:Inflammatory factor (IL-18, PCT,CRP) and APACHE II score are treating after3days, have statistical significance (P<0.05), after14days which have statistical significance (P<0.01). Comparison among groups, medium dose group compares with low dose group after3days which have statistical significance (P<0.05), compares with low dose after14days which have statistical significance (P<0.01).6. High dose group:Inflammatory factor (IL-18, PCT, CRP)and APACHE Ⅱ score are treating after3day, have statistical significance (P<0.05), after7days, which have statistical significance(P<0.01). Comparison among groups:high dose group compares with medium dose group after3days which have statistical significance (P<0.05), compared with low dose after7days which have statistical significance (P<0.01).7. accumulative survival rate of the control group, low dose group, medium dose group and high dose groups were used Kaplan-Meier analysis during14days: the cumulative survival rate of four groups of patients with sepsis with gradually increased with time.ConclusionsHigh dose Xuebijing injection was given to patients with sepsis in early phase helps to temperature, heart rate and white blood cell level; mediate microcirulation and oxygen metabolic disorders, control the inflammatory response to blocking SIRS turn to MODS; protect the viscera function and improve blood coagulation, at the same time, improve septic patients14days cumulative survival rate.更多还原