血必净对重症创伤患者炎性因子、生化指标及脏器功能评分的影响
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摘要
目的分析血必净对重症创伤患者炎性因子、生化指标及脏器功能评分影响。方法收集重症创伤患者80例,随机分为研究组与对照组,每组40例。2组患者入院后均给予积极的外科手术清创、行积极的液体复苏治疗、抗生素控制感染、给予积极的镇静、镇痛处理及器官功能保护等综合处理。观察组在此基础上应用50 ml血必净注射液加0.9%氯化钠溶液100 ml静脉滴注,2/d次,连用7 d;对照组应用0.9%氯化钠溶液100 ml作为安慰剂。检测血清白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、降钙素原(PCT)与脂联素(APN)水平变化。并在第5天检测2组患者白蛋白水平、肝酶及胆碱酯酶水平比较差异。评估治疗后患者急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)与序贯器官衰竭评分(SOFA),分析2组患者各项指标的差别及病死率情况。结果治疗后2组IL-6、TNF-α、CRP、PCT水平均下降,APN水平高于治疗前,且研究组上升、下降幅度更显著,差异均有统计学意义(P<0.05);治疗后血清总蛋白、白蛋白水平较治疗前明显升高,肝酶及胆碱酯酶水平显著降低,且研究组上升、下降幅度显著高于对照组,差异均有统计学意义(P<0.05);治疗后研究组APACHEⅡ评分、SOFA评分均低于对照组,差异均有统计学意义(P<0.05);研究组的感染率、病死率及住院时间明显低于对照组,差异均有统计学意义(P<0.05)。结论对重症创伤患者应用血必净注射液可以有效地抑制炎性因子,可明显减轻患者炎性损伤,增加胆碱酯酶活性及肝脏蛋白合成能力,减少肝脏损伤;降低感染率,减少死亡率,缩短治疗疗程,值得推广应用。
Objective To investigate the effects of Xuebijing on inflammatory factors,blood biochemical indexes and organ function scores in patients with severe trauma. Methods A total of 80 patients with severe trauma were randomly divided into research group( n = 40) and control group( n = 40). The patients in both groups were treated by ositive surgical debridement,positive liquid resuscitation,controlling infection by antibiotics,positive sedation,analgesia treatment and organ function protection after hospitalization. On this basis,the patients in research group were given Xuebijing 50 ml combined with 0. 9% sodium chloride solution 100 ml by intravenous injection,twice a day,continuely for 7 days,however,the patients in control group were given 0. 9% sodium chloride solution 100 ml by intravenous injection as placebo. The serum levels of interleukin 6( IL-6),tumor necrosis factor-α( TNF-α),C reactive protein( CRP),procalcitonin( PCT) and adiponectin( APN) were measured before and after treatment. The serum levels of albumin,liver enzymes and cholinesterase at 5 d after treatment were detected and compared between two groups. Moreover the acute physiological and chronic health status scores( APACHE Ⅱ) as well as sequential organ failure score( SOFA) and fatality rate were observed and compared between two groups. Results After treatment the levels of IL-6,TNF-α,CRP and PCT were significantly decreased in both groups,as compared with those before treatment,however,the APN levels were significantly increased,moreover,the increase degree and decrease degree in research group were more significant than those in control group( P < 0. 05). The serum levels of total protein and albumin after treament were significantly increased in both groups, but the levels of liver enzymes and cholinesterase were significantly decreased,moreover,the increase degree and decrease degree in research group were more significant than those in control group( P < 0. 05). After treatment,APACHE Ⅱ and SOFA scores in research group were significantly lower than those in control group( P < 0. 05),in addition,the infection rate,mortality rate and hospitalization time in research group were significantly lower than those in control group( P < 0. 05). Conclusion Xuebijing injection can effectively inhibit inflammatory factors,obviously alleviate inflammatory injury,increase cholinesterase activity and liver protein synthesis ability,reduce liver injury of patients with severe trauma,which can also reduce the infection rate and mortality,shorten treatm ent course,therefor,which is worthy of popularization and application.
Objective To investigate the effects of Xuebijing on inflammatory factors,blood biochemical indexes and organ function scores in patients with severe trauma. Methods A total of 80 patients with severe trauma were randomly divided into research group( n = 40) and control group( n = 40). The patients in both groups were treated by ositive surgical debridement,positive liquid resuscitation,controlling infection by antibiotics,positive sedation,analgesia treatment and organ function protection after hospitalization. On this basis,the patients in research group were given Xuebijing 50 ml combined with 0. 9% sodium chloride solution 100 ml by intravenous injection,twice a day,continuely for 7 days,however,the patients in control group were given 0. 9% sodium chloride solution 100 ml by intravenous injection as placebo. The serum levels of interleukin 6( IL-6),tumor necrosis factor-α( TNF-α),C reactive protein( CRP),procalcitonin( PCT) and adiponectin( APN) were measured before and after treatment. The serum levels of albumin,liver enzymes and cholinesterase at 5 d after treatment were detected and compared between two groups. Moreover the acute physiological and chronic health status scores( APACHE Ⅱ) as well as sequential organ failure score( SOFA) and fatality rate were observed and compared between two groups. Results After treatment the levels of IL-6,TNF-α,CRP and PCT were significantly decreased in both groups,as compared with those before treatment,however,the APN levels were significantly increased,moreover,the increase degree and decrease degree in research group were more significant than those in control group( P < 0. 05). The serum levels of total protein and albumin after treament were significantly increased in both groups, but the levels of liver enzymes and cholinesterase were significantly decreased,moreover,the increase degree and decrease degree in research group were more significant than those in control group( P < 0. 05). After treatment,APACHE Ⅱ and SOFA scores in research group were significantly lower than those in control group( P < 0. 05),in addition,the infection rate,mortality rate and hospitalization time in research group were significantly lower than those in control group( P < 0. 05). Conclusion Xuebijing injection can effectively inhibit inflammatory factors,obviously alleviate inflammatory injury,increase cholinesterase activity and liver protein synthesis ability,reduce liver injury of patients with severe trauma,which can also reduce the infection rate and mortality,shorten treatm ent course,therefor,which is worthy of popularization and application.
引文
1黄顺伟,管向东,陈娟,等.创伤性严重脓毒症和多器官功能障碍综合征免疫调理治疗的临床研究和远期评价.中国危重病急救医学,2006,18:653-656.
2 郭剑颖,韦文韬,吕慧艳.创伤后脓毒症患者凝血功能紊乱及其MODS评分的相关性分析.解放军医学杂志,2007,32:625.
3 陈佳君,白祥军,李仁杰,等.创伤性脓毒症患者外周血Th/Treg平衡变化及临床意义.中华创伤杂志,2012,28:885-887.
4 瞿星光,张朝晖,周刚,等.“衡炎方”肺创伤脓毒症患者炎症反应及凝血功能的影响.江苏中医药,2011,43:32-35.
5 姚咏明,刘峰,盛志勇.多器官工鞥障碍综合征与脏器功能支持策略.中华急诊医学杂志,2006,15:293-294.
6 姚咏明,栾颖.提高对创伤感染及其并发症的认识.临床急诊杂志,2011,12:361-362.
7 吴国豪.特殊营养素在外科患者中的应用.中华胃肠外科杂志,2012,15:433-435.
8 王韬,姚元章,张连阳,等.60例创伤创面感染细菌学分析.重庆医学,2008,37:1445-1446.
9 邱春兰,王兴勇.全身炎症反应综合征发病机制研究进展.西部医学,2009,21:662-665.
10 Utsunomiya I,Ito M,Oh-ishi S.Generation of inflammatory cytokinesin zymosan-induced neutrophil chemoattractant(CINC)in vivo.Cytokine,1998,10:956-963.
11 张畔,曹书华,崔克亮,等.血必净对多脏器功能障碍综合征单核细胞HLA-DR表达影响的研究.中国中西医结合急救杂志,2002,9:21-23.
12 邓烈华,姚华国.邵义明.血必净对脓毒血症患者前降钙索影响的临床观察.实用医技杂志,2005,12:1590-1591.
13 刘清泉,粱腾胃,刘红旭,等.血必净注射液治疗脓毒症的多中心临床研究.北京中医,2007,26:15-18.
14 Mokart D,Merlin M,Sanninia,et al.Procalcitonin,interleukin 6 and systemic inflammatory response syndrome(SIRS):early markers of postoperative sepsis after major surgery.Br J Anaesth,2005,94:767-773.
15 Matsukawa A,Yoshimur T,Miyamoto K,et al.Analysis of the inflammatory cytokine network among TNF alpha,IL-1 beta,IL-1 receptor antagonist,and IL-8 in LPS-induced rabbit arthritis.Lab Invest,1997,76:629-638.
16 Haupt W,Fritzsche H,Hohenberger W,et al.Selective cytokine release induced by serum and separated plasma from septic patients.Eur J Sury1996,162:769-776.
17 李宛霞,陶少宇,李国平.创伤患者血清C反应蛋白的变化及意义.实用临床医学,2008,9:1-6.
18 平虎,汤进,浦燕,等.血清皮质醇、脂联素、一氧化氮等水平与老年急性创伤患者预后的关系.疑难病杂志,2016,15:821-823.
19 韩芳,孙仁华,徐云祥.血必净治疗急性呼吸窘迫综合征疗效评价.浙江中西医结合杂志,2006,16:680-681.
20 丁俊涛,王学伦,方荣新.创伤后脓毒症的外科控制.中华普外科手术学杂志,2011,5:108-109.
21 律师.血必净佐治老年重症肺炎45例及对免疫指标的影响.中国药业,2015,32:216.
2 郭剑颖,韦文韬,吕慧艳.创伤后脓毒症患者凝血功能紊乱及其MODS评分的相关性分析.解放军医学杂志,2007,32:625.
3 陈佳君,白祥军,李仁杰,等.创伤性脓毒症患者外周血Th/Treg平衡变化及临床意义.中华创伤杂志,2012,28:885-887.
4 瞿星光,张朝晖,周刚,等.“衡炎方”肺创伤脓毒症患者炎症反应及凝血功能的影响.江苏中医药,2011,43:32-35.
5 姚咏明,刘峰,盛志勇.多器官工鞥障碍综合征与脏器功能支持策略.中华急诊医学杂志,2006,15:293-294.
6 姚咏明,栾颖.提高对创伤感染及其并发症的认识.临床急诊杂志,2011,12:361-362.
7 吴国豪.特殊营养素在外科患者中的应用.中华胃肠外科杂志,2012,15:433-435.
8 王韬,姚元章,张连阳,等.60例创伤创面感染细菌学分析.重庆医学,2008,37:1445-1446.
9 邱春兰,王兴勇.全身炎症反应综合征发病机制研究进展.西部医学,2009,21:662-665.
10 Utsunomiya I,Ito M,Oh-ishi S.Generation of inflammatory cytokinesin zymosan-induced neutrophil chemoattractant(CINC)in vivo.Cytokine,1998,10:956-963.
11 张畔,曹书华,崔克亮,等.血必净对多脏器功能障碍综合征单核细胞HLA-DR表达影响的研究.中国中西医结合急救杂志,2002,9:21-23.
12 邓烈华,姚华国.邵义明.血必净对脓毒血症患者前降钙索影响的临床观察.实用医技杂志,2005,12:1590-1591.
13 刘清泉,粱腾胃,刘红旭,等.血必净注射液治疗脓毒症的多中心临床研究.北京中医,2007,26:15-18.
14 Mokart D,Merlin M,Sanninia,et al.Procalcitonin,interleukin 6 and systemic inflammatory response syndrome(SIRS):early markers of postoperative sepsis after major surgery.Br J Anaesth,2005,94:767-773.
15 Matsukawa A,Yoshimur T,Miyamoto K,et al.Analysis of the inflammatory cytokine network among TNF alpha,IL-1 beta,IL-1 receptor antagonist,and IL-8 in LPS-induced rabbit arthritis.Lab Invest,1997,76:629-638.
16 Haupt W,Fritzsche H,Hohenberger W,et al.Selective cytokine release induced by serum and separated plasma from septic patients.Eur J Sury1996,162:769-776.
17 李宛霞,陶少宇,李国平.创伤患者血清C反应蛋白的变化及意义.实用临床医学,2008,9:1-6.
18 平虎,汤进,浦燕,等.血清皮质醇、脂联素、一氧化氮等水平与老年急性创伤患者预后的关系.疑难病杂志,2016,15:821-823.
19 韩芳,孙仁华,徐云祥.血必净治疗急性呼吸窘迫综合征疗效评价.浙江中西医结合杂志,2006,16:680-681.
20 丁俊涛,王学伦,方荣新.创伤后脓毒症的外科控制.中华普外科手术学杂志,2011,5:108-109.
21 律师.血必净佐治老年重症肺炎45例及对免疫指标的影响.中国药业,2015,32:216.
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