参麦注射液联合氢化可的松治疗儿童脓毒症的临床研究
|
摘要
目的探讨参麦注射液联合氢化可的松注射液治疗儿童脓毒症的临床疗效。方法选取2015年6月—2017年6月内蒙古医科大学附属医院收治的脓毒症患儿96例作为研究对象,根据入院顺序将患儿随机分为对照组和治疗组,每组各48例。对照组患儿静脉滴注氢化可的松注射液,50 mg氢化可的松注射液与0.5 g维生素C加入5%葡萄糖注射液250 mL中,1次/d。治疗组在对照组治疗的基础上静脉滴注参麦注射液,50 mL加入5%葡萄糖注射液200 mL,1次/d。两组患儿均连续治疗7 d。观察两组患儿临床疗效,同时比较两组治疗前后的体温、心率、急性生理学与慢性健康状况(APACHEⅡ)评分、血乳酸水平、24h乳酸清除率、急诊重症监护室(ICU)入住时长、7d死亡率、血清学指标和免疫细胞比例。结果治疗后,对照组和治疗组的总有效率分别为81.25%、93.75%,两组比较差异具有统计学意义(P<0.05)。治疗后,两组体温、心率、APACHEⅡ评分、血乳酸水平均显著降低(P<0.05);而治疗后治疗组上述指标水平明显均低于对照组(P<0.05)。治疗后,治疗组的24 h乳酸清除率显著高于对照组,ICU入住时间、7 d死亡率均显著低于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、血清降钙素原(PCT)、C反应蛋白(CRP)、TOLL样受体4(TLR4)、Toll/IL-1受体衔接蛋白(TIRAP)水平均显著降低(P<0.05);且治疗后治疗组血清学指标水平均显著低于对照组(P<0.05)。治疗后,两组CD4+T细胞、NK细胞比例均显著升高,CD8+T细胞比例显著降低,同组治疗前后比较差异具有统计学意义(P<0.05),且治疗后治疗组患者免疫细胞水平显著优于对照组,两组比较差异具有统计学意义(P<0.05)。结论参麦注射液联合氢化可的松注射液治疗儿童脓毒症疗效显著,可显著降低患儿机体炎症反应并改善患儿免疫功能,具有较好的临床推广应用价值。
Objective To investigate the clinical effect of Shenmai Injection combined with Hydrocortisone Injection in treatment of children's sepsis. Methods Children(96 cases) with sepsis in the Affiliated Hospital of Inner Mongolia Medical University from June 2015 to June 2017 were randomly divided into control and treatment groups according to the order of admission, and each group had 48 cases. Children in the control group were iv administered with Hydrocortisone Injection, 50 mg Hydrocortisone Injection and 0.5 g vitamin C were added into 5% glucose injection 250 m L, once daily. Children in the treatment group were iv administered with Shenmai Injection, 50 m L added into 5% glucose injection 200 m L, once daily. Children in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the body temperature, heart rate, APACHE II score, blood lactate, ICU length of stay, 24 h lactate clearance rate, 7 d mortality rate, serological indicator levels, and immune cell levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.25% and 93.75%, and there were differences between two groups(P < 0.05). After treatment, the body temperature, heart rate, APACHE II score, and blood lactate level were significantly decreased(P < 0.05). And these indicators in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment, the 24 h lactate clearance rate in the treatment group were significantly higher than those in the control group, but the ICU length of stay and 7 d mortality rate in the treatment group were significantly lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, the levels of TNF-α, IL-6, IL-10, PCT, CRP, TLR4, and TIRAP were significantly decreased(P < 0.05). And serological indicator levels in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment, levels of CD4+ T and NK cells in two groups were significantly increased, but the levels of CD8+ T cells were decreased, and the difference was statistically significant in the same group(P < 0.05). And the immune cell levels in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Shenmai Injection combined with Hydrocortisone Injection has significant curative effect in treatment of children's sepsis, can significantly reduce the inflammation, and improve the immune function, which has a certain clinical application value.
Objective To investigate the clinical effect of Shenmai Injection combined with Hydrocortisone Injection in treatment of children's sepsis. Methods Children(96 cases) with sepsis in the Affiliated Hospital of Inner Mongolia Medical University from June 2015 to June 2017 were randomly divided into control and treatment groups according to the order of admission, and each group had 48 cases. Children in the control group were iv administered with Hydrocortisone Injection, 50 mg Hydrocortisone Injection and 0.5 g vitamin C were added into 5% glucose injection 250 m L, once daily. Children in the treatment group were iv administered with Shenmai Injection, 50 m L added into 5% glucose injection 200 m L, once daily. Children in two groups were treated for 7 d. After treatment, the clinical efficacy was evaluated, and the body temperature, heart rate, APACHE II score, blood lactate, ICU length of stay, 24 h lactate clearance rate, 7 d mortality rate, serological indicator levels, and immune cell levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 81.25% and 93.75%, and there were differences between two groups(P < 0.05). After treatment, the body temperature, heart rate, APACHE II score, and blood lactate level were significantly decreased(P < 0.05). And these indicators in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment, the 24 h lactate clearance rate in the treatment group were significantly higher than those in the control group, but the ICU length of stay and 7 d mortality rate in the treatment group were significantly lower than those in the control group, and there were differences between two groups(P < 0.05). After treatment, the levels of TNF-α, IL-6, IL-10, PCT, CRP, TLR4, and TIRAP were significantly decreased(P < 0.05). And serological indicator levels in the treatment group were significantly lower than those in the control group(P < 0.05). After treatment, levels of CD4+ T and NK cells in two groups were significantly increased, but the levels of CD8+ T cells were decreased, and the difference was statistically significant in the same group(P < 0.05). And the immune cell levels in the treatment group were significantly better than those in the control group, with significant difference between two groups(P < 0.05). Conclusion Shenmai Injection combined with Hydrocortisone Injection has significant curative effect in treatment of children's sepsis, can significantly reduce the inflammation, and improve the immune function, which has a certain clinical application value.
引文
[1]方伯梁,钱素云.儿童脓毒症流行病学趋势及特点[J].中国实用儿科杂志, 2017, 32(6):414-416.
[2]李亮,曹昌魁,聂时南.小剂量氢化可的松治疗严重脓毒症患者的疗效观察[J].东南国防医药,2016,18(5):455-457.
[3]李盼,王婷,付姝菲,等.基于Meta分析的参附、参麦注射液临床作用比较[J].中草药,2016,47(16):2949-2959.
[4]樊寻梅,武志远.国际儿科脓毒症定义会议介绍[J].中华儿科杂志, 2005, 43(8):618-620.
[5]孙传兴.临床疾病诊断依据治愈好转标准[M].第2版.北京:人民军医出版社, 1998:250-251.
[6]陈淑桂,刘慧姝,何翠媚. APACHE II评分在ICU产科危重患者监护中的应用[J].中国实用护理杂志,2005,21(4):34-35.
[7]李瑞伟,李秀芝,郝正玮,等.参附注射液联合低剂量氢化可的松对重度脓毒血症患者炎症因子及免疫功能的影响[J].临床肺科杂志, 2015, 20(7):1244-1247.
[8]宁小平,王金莉,何东阳,等.参麦注射液对脓毒血症患者血清细胞因子及超敏C-反应蛋白的影响[J].中国当代医药, 2012, 19(18):78-79.
[9]赵雪峰,魏秀华.脓毒血症患者血清IL-6以及IL-10的表达及对免疫功能的影响[J].中国实验诊断学,2017,21(2):279-281.
[10]周素芽,王丽娜,周琴,等.血清降钙素原与超敏C-反应蛋白在新生儿感染性疾病中的表达及其临床评价[J].中华医院感染学杂志, 2016, 26(12):2837-2839.
[11]齐眀禄,杨敬平,银雪,等.外周血中TLR4、TIRAP表达与脓毒症相关性研究[J].临床肺科杂志,2015,20(1):19-22.
[12]李华福,谢群,叶啸,等. CD3+, CD4+及CD8+T淋巴细胞数目改变作为早期诊断脓毒血症指标可行性的Meta分析[J].临床与病理杂志,2017,37(7):1450-1459.
[13]常海霞,张丽波,张中馥.脓毒症患儿外周血CD4+CD25+Treg细胞含量与全身炎症反应程度的相关性研究[J].海南医学院学报, 2017, 23(12):1672-1674.
[14]张玉景,张君利,李鹏,等.他汀类药物联合参麦注射液治疗脓毒症的机制研究[J].海南医学院学报,2016, 22(23):2911-2914.
[2]李亮,曹昌魁,聂时南.小剂量氢化可的松治疗严重脓毒症患者的疗效观察[J].东南国防医药,2016,18(5):455-457.
[3]李盼,王婷,付姝菲,等.基于Meta分析的参附、参麦注射液临床作用比较[J].中草药,2016,47(16):2949-2959.
[4]樊寻梅,武志远.国际儿科脓毒症定义会议介绍[J].中华儿科杂志, 2005, 43(8):618-620.
[5]孙传兴.临床疾病诊断依据治愈好转标准[M].第2版.北京:人民军医出版社, 1998:250-251.
[6]陈淑桂,刘慧姝,何翠媚. APACHE II评分在ICU产科危重患者监护中的应用[J].中国实用护理杂志,2005,21(4):34-35.
[7]李瑞伟,李秀芝,郝正玮,等.参附注射液联合低剂量氢化可的松对重度脓毒血症患者炎症因子及免疫功能的影响[J].临床肺科杂志, 2015, 20(7):1244-1247.
[8]宁小平,王金莉,何东阳,等.参麦注射液对脓毒血症患者血清细胞因子及超敏C-反应蛋白的影响[J].中国当代医药, 2012, 19(18):78-79.
[9]赵雪峰,魏秀华.脓毒血症患者血清IL-6以及IL-10的表达及对免疫功能的影响[J].中国实验诊断学,2017,21(2):279-281.
[10]周素芽,王丽娜,周琴,等.血清降钙素原与超敏C-反应蛋白在新生儿感染性疾病中的表达及其临床评价[J].中华医院感染学杂志, 2016, 26(12):2837-2839.
[11]齐眀禄,杨敬平,银雪,等.外周血中TLR4、TIRAP表达与脓毒症相关性研究[J].临床肺科杂志,2015,20(1):19-22.
[12]李华福,谢群,叶啸,等. CD3+, CD4+及CD8+T淋巴细胞数目改变作为早期诊断脓毒血症指标可行性的Meta分析[J].临床与病理杂志,2017,37(7):1450-1459.
[13]常海霞,张丽波,张中馥.脓毒症患儿外周血CD4+CD25+Treg细胞含量与全身炎症反应程度的相关性研究[J].海南医学院学报, 2017, 23(12):1672-1674.
[14]张玉景,张君利,李鹏,等.他汀类药物联合参麦注射液治疗脓毒症的机制研究[J].海南医学院学报,2016, 22(23):2911-2914.