血必净注射液在重症急性胰腺炎并发脓毒血症患者中的应用
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摘要
目的探讨血必净注射液在重症急性胰腺炎并发脓毒血症患者中的临床应用效果。方法选取2016年6月至2017年12月在三亚市人民医院重症医学科住院治疗的重症急性胰腺炎并发脓毒血症患者79例,按随机数表法分为观察组41例和对照组38例。两组均予抗重症急性胰腺炎并发脓毒血症的对症治疗,并在此基础上,观察组应用血必净注射液,对照组予生理盐水替换,连续治疗7 d,治疗结束后比较两组患者的临床疗效、血清C反应蛋白(CRP)及白细胞(WBC)水平、急性生理功能和慢性健康状况评分系统Ⅱ(APACHEⅡ评分)、手术率、凝血和免疫功能。结果治疗7 d结束时,观察组患者的治疗显效率为48.78%,临床治疗总有效率为92.68%,均明显高于对照组的23.68%和86.84%,差异均有统计学意义(P<0.05);观察组患者的血清WBC为(10.98±2.23)×109/L、CRP为(10.73±3.85) mg/L、APACHEⅡ评分为(6.03±1.55)分、手术率为12.19%,分别与对照组的(12.65±3.37)×109/L、(14.98±5.64) mg/L、(9.46±2.58)分和34.21%比较,差异均有统计学意义(P<0.05);观察组患者的凝血酶原时间(PT)(11.38±1.46) s、活化部分凝血活酶时间(APTT)(40.82±6.98) s、凝血酶时间(TT)(13.86±2.08) s和纤维蛋白原(FIB)(3.34±0.75) g/L,分别与对照组的(14.41±1.57) s、(37.33±6.86) s、(16.42±2.15) s和(2.75±0.89) g/L比较,差异均有统计学意义(P<0.05);观察组患者的B细胞(23.02±5.38)%、NK细胞(22.53±5.75)%和CD3+(49.85±8.78)%、CD4+(27.56±6.03)%、CD8+T细胞(21.74±5.53)%比例及CD4+/CD8+值(1.97±0.72),分别与对照组的(20.46±5.85)%、(18.78±6.49)%和(45.67±9.13)%、(24.75±6.48)%、(18.96±6.39)%及(1.51±0.77)比较,差异均有统计学意义(P<0.05)。结论重症急性胰腺炎并发脓毒血症患者应用血必净注射液治疗具有良好的抗炎、抗凝及调节机体免疫能力的作用,其临床疗效较肯定。
Objective To explore the clinical application effect of Xuebijing injection in patients with severe acute pancreatitis complicated with sepsis. Methods From June 2016 to December 2017, 79 patients with severe acute pancreatitis complicating sepsis were selected from Department of Critical Care Medicine, the People's Hospital of Sanya City, which were assigned into 41 patients in the observation group and 38 patients in the control group by random number table. Based on symptomatic treatment, the patients in the observation group were treated with Xuebijing injection, and those in the control group were given saline instead, both continuously for 7 d. Then the clinical efficacy, serum C-reactive protein(CRP), and white blood cell(WBC) levels, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, surgical rate, coagulation and immune function of the two groups were compared. Results After treatment, the markedly effective rate and the total effective rate in the observation group were 48.78% and 92.68%,which were significantly higher than 23.68% and 86.84% in the control group(P<0.05). The serum WBC, CRP,APACHEⅡ score, and surgical rate were(10.98±2.23)×109/L,(10.73±3.85) mg/L,(6.03±1.55), and 12.19% in the observation group, versus(12.65±3.37)×109/L,(14.98±5.64) mg/L,(9.46±2.58), and 34.21% in the control group(P<0.05).The prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), and fibrinogen(FIB)were(11.38±1.46) s,(40.82±6.98) s,(13.86±2.08) s,(3.34±0.75) g/L in the observation group, versus(14.41±1.57) s,(37.33±6.86) s,(16.42±2.15) s, and(2.75±0.89) g/L in the control group(P<0.05). The B cells, NK cells, CD3+, CD4+,CD8+T cells levels, and CD4+/CD8+value were(23.02±5.38)%,(22.53±5.75)%,(49.85±8.78)%,(27.56±6.03)%,(21.74±5.53)%, and(1.97 ± 0.72) in the observation group, versus(20.46 ± 5.85)%,(18.78 ± 6.49)%,(45.67 ± 9.13)%,(24.75 ±6.48)%,(18.96±6.39)%, and(1.51±0.77) in the control group(P<0.05). Conclusion For patients with severe acute pancreatitis complicating sepsis, Xuebijing injection has good anti-inflammatory, anti-coagulant effect, and can regulate the immune ability of the body.
Objective To explore the clinical application effect of Xuebijing injection in patients with severe acute pancreatitis complicated with sepsis. Methods From June 2016 to December 2017, 79 patients with severe acute pancreatitis complicating sepsis were selected from Department of Critical Care Medicine, the People's Hospital of Sanya City, which were assigned into 41 patients in the observation group and 38 patients in the control group by random number table. Based on symptomatic treatment, the patients in the observation group were treated with Xuebijing injection, and those in the control group were given saline instead, both continuously for 7 d. Then the clinical efficacy, serum C-reactive protein(CRP), and white blood cell(WBC) levels, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, surgical rate, coagulation and immune function of the two groups were compared. Results After treatment, the markedly effective rate and the total effective rate in the observation group were 48.78% and 92.68%,which were significantly higher than 23.68% and 86.84% in the control group(P<0.05). The serum WBC, CRP,APACHEⅡ score, and surgical rate were(10.98±2.23)×109/L,(10.73±3.85) mg/L,(6.03±1.55), and 12.19% in the observation group, versus(12.65±3.37)×109/L,(14.98±5.64) mg/L,(9.46±2.58), and 34.21% in the control group(P<0.05).The prothrombin time(PT), activated partial thromboplastin time(APTT), thrombin time(TT), and fibrinogen(FIB)were(11.38±1.46) s,(40.82±6.98) s,(13.86±2.08) s,(3.34±0.75) g/L in the observation group, versus(14.41±1.57) s,(37.33±6.86) s,(16.42±2.15) s, and(2.75±0.89) g/L in the control group(P<0.05). The B cells, NK cells, CD3+, CD4+,CD8+T cells levels, and CD4+/CD8+value were(23.02±5.38)%,(22.53±5.75)%,(49.85±8.78)%,(27.56±6.03)%,(21.74±5.53)%, and(1.97 ± 0.72) in the observation group, versus(20.46 ± 5.85)%,(18.78 ± 6.49)%,(45.67 ± 9.13)%,(24.75 ±6.48)%,(18.96±6.39)%, and(1.51±0.77) in the control group(P<0.05). Conclusion For patients with severe acute pancreatitis complicating sepsis, Xuebijing injection has good anti-inflammatory, anti-coagulant effect, and can regulate the immune ability of the body.
引文
[1]张蕾.重症急性胰腺炎(SAP)的常见并发症与护理措施研究[J].实用临床护理学杂志, 2017, 2(7):54-56.
[2] Besselink MG, de Bruijn MT, Rutten JP, et al. Surgical intervention in patients with necrotizing pancreatitis[J]. Br J Surg, 2006, 93(5):593-599.
[3]熊炯析,王春友,李晓辉,等.分阶段营养支持对重症急性胰腺炎患者的影响[J].中国实用外科杂志, 2005, 25(1):44-46.
[4]中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南[J].中国实用内科杂志, 2013, 33(7):530-535.
[5]郭玉友.急性重症胰腺炎与凝血功能的相关性研究[J].中国城乡企业卫生, 2017, 32(187):31-34.
[6]杨德淑,杨平,张艳,等.不同抗凝方案在严重脓毒血症血小板减少患者CRRT中的应用[J].重庆医学, 2014, 43(28):3724-3726.
[7]颜庆余.重症急性胰腺炎治疗方法新进展研究[J].中国疗养医学,2016, 25(2):130-132.
[8]吴江莹,刘晓新.血必净注射液的抗炎作用机制研究进展[J].检验医学与临床, 2013, 10(15):2030-2032.
[9]孙红双,吕菁君,魏捷.血必净注射液对脓毒症患者凝血功能影响分析[J].临床药物治疗杂志, 2015, 13(4):41-46.
[10]张友来,邹立津,辛国华,等.血必净注射液降低脓毒症死亡率有效性的研究[J].中成药, 2010, 32(10):1668-1670.
[11] Vincent JL, Habib AM, Verdant C, et al. Sepsis diagnosis and management:work in progress[J]. Minerva Anestesiol, 2006, 72(3):87-96.
[12]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社, 1993:38.
[13] Hunziker S, Celi LA, Lee J. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients[J]. Crit Care, 2012, 16(3):R89.
[14] Angus DC, van der Poll T. Severe sepsis and septic shock[J]. N Engl J Med, 2013, 369(9):840-851.
[15]齐中意,彭湘鹤,颜璐,等.低分子肝素对脓毒血症患者凝血功能和肾功能的影响[J].解放军预防医学杂志, 2018, 36(1):84-86.
[16]吴敏助.复方丹参注射液联合生长抑素治疗重症急性胰腺炎的疗效观察[J].现代消化及介入诊疗, 2017, 22(1):72-74.
[17]许业钦,刘艾娇. CRRT治疗脓毒血症中不同抗凝方案的治疗效果[J].实用临床护理学杂志, 2017, 2(19):109-110.
[18]许国振,许源.从瘀热证论治脓毒血症的理论及临床研究[J].中国中医急症, 2016, 25(11):2069-2071.
[19]赵研,常毓颖.加味桃红四物汤对重症脓毒症疗效的临床研究[J].中医药学报, 2010, 38(6):36-39.
[20]王宇歆,周静,杜凡,等.凉血活血方有效组分对脓毒症大鼠肠道血液循环及氧供的影响[J].中国中西医结合外科杂志, 2012, 18(4):372-375.
[21]金泓,赖旭东,关信民,等.血必净注射液在脓毒血症治疗中的疗效观察[J].中医临床研究, 2017, 9(36):71-73.
[22]高树辉.血必净对新生儿脓毒血症的疗效及对C反应蛋白和降钙素原的影响[J].广东医学, 2015, 36(16):2579-2581.
[23]朱永,李娜,陈民科,等.血必净联合常规西药治疗严重脓毒血症的临床疗效观察[J].中药药理与临床, 2016, 32(2):199-201.
[24]茅尧生,吕铁,孙雪东,等.血必净对严重多发伤早期全身炎症反应的影响[J].中华创伤杂志, 2012, 24(1):54-56.
[25]逯锦涛,张津华,林磊,等.早期集束化治疗对急性重症胰腺炎并发脓毒症休克患者预后的影响[J].世界华人消化杂志, 2012, 14(7):619-621.
[26]隆云,郭新华,刘大为,等.重症急性坏死性胰腺炎临床治疗流程研究[J].中国实用外科杂志, 2012, 32(7):565-567.
[2] Besselink MG, de Bruijn MT, Rutten JP, et al. Surgical intervention in patients with necrotizing pancreatitis[J]. Br J Surg, 2006, 93(5):593-599.
[3]熊炯析,王春友,李晓辉,等.分阶段营养支持对重症急性胰腺炎患者的影响[J].中国实用外科杂志, 2005, 25(1):44-46.
[4]中华医学会消化病学分会胰腺疾病学组.中国急性胰腺炎诊治指南[J].中国实用内科杂志, 2013, 33(7):530-535.
[5]郭玉友.急性重症胰腺炎与凝血功能的相关性研究[J].中国城乡企业卫生, 2017, 32(187):31-34.
[6]杨德淑,杨平,张艳,等.不同抗凝方案在严重脓毒血症血小板减少患者CRRT中的应用[J].重庆医学, 2014, 43(28):3724-3726.
[7]颜庆余.重症急性胰腺炎治疗方法新进展研究[J].中国疗养医学,2016, 25(2):130-132.
[8]吴江莹,刘晓新.血必净注射液的抗炎作用机制研究进展[J].检验医学与临床, 2013, 10(15):2030-2032.
[9]孙红双,吕菁君,魏捷.血必净注射液对脓毒症患者凝血功能影响分析[J].临床药物治疗杂志, 2015, 13(4):41-46.
[10]张友来,邹立津,辛国华,等.血必净注射液降低脓毒症死亡率有效性的研究[J].中成药, 2010, 32(10):1668-1670.
[11] Vincent JL, Habib AM, Verdant C, et al. Sepsis diagnosis and management:work in progress[J]. Minerva Anestesiol, 2006, 72(3):87-96.
[12]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社, 1993:38.
[13] Hunziker S, Celi LA, Lee J. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients[J]. Crit Care, 2012, 16(3):R89.
[14] Angus DC, van der Poll T. Severe sepsis and septic shock[J]. N Engl J Med, 2013, 369(9):840-851.
[15]齐中意,彭湘鹤,颜璐,等.低分子肝素对脓毒血症患者凝血功能和肾功能的影响[J].解放军预防医学杂志, 2018, 36(1):84-86.
[16]吴敏助.复方丹参注射液联合生长抑素治疗重症急性胰腺炎的疗效观察[J].现代消化及介入诊疗, 2017, 22(1):72-74.
[17]许业钦,刘艾娇. CRRT治疗脓毒血症中不同抗凝方案的治疗效果[J].实用临床护理学杂志, 2017, 2(19):109-110.
[18]许国振,许源.从瘀热证论治脓毒血症的理论及临床研究[J].中国中医急症, 2016, 25(11):2069-2071.
[19]赵研,常毓颖.加味桃红四物汤对重症脓毒症疗效的临床研究[J].中医药学报, 2010, 38(6):36-39.
[20]王宇歆,周静,杜凡,等.凉血活血方有效组分对脓毒症大鼠肠道血液循环及氧供的影响[J].中国中西医结合外科杂志, 2012, 18(4):372-375.
[21]金泓,赖旭东,关信民,等.血必净注射液在脓毒血症治疗中的疗效观察[J].中医临床研究, 2017, 9(36):71-73.
[22]高树辉.血必净对新生儿脓毒血症的疗效及对C反应蛋白和降钙素原的影响[J].广东医学, 2015, 36(16):2579-2581.
[23]朱永,李娜,陈民科,等.血必净联合常规西药治疗严重脓毒血症的临床疗效观察[J].中药药理与临床, 2016, 32(2):199-201.
[24]茅尧生,吕铁,孙雪东,等.血必净对严重多发伤早期全身炎症反应的影响[J].中华创伤杂志, 2012, 24(1):54-56.
[25]逯锦涛,张津华,林磊,等.早期集束化治疗对急性重症胰腺炎并发脓毒症休克患者预后的影响[J].世界华人消化杂志, 2012, 14(7):619-621.
[26]隆云,郭新华,刘大为,等.重症急性坏死性胰腺炎临床治疗流程研究[J].中国实用外科杂志, 2012, 32(7):565-567.