抗凝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:探讨抗凝在重症急性胰腺炎并发脓毒血症患者中的临床疗效及其对患者免疫功能的影响。方法:选取重症急性胰腺炎并发脓毒血症患者70例,按随机数字表法分为观察组35例和对照组35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,观察组应用低分子肝素钠,对比两组治疗效果。结果:最终共有66例患者完成临床研究,其中观察组34例和对照组32例。观察组显效31例,有效3例,无效0例;对照组显效22例,有效10例,无效0例。其中,观察组显效率及临床疗效与对照组比较,差异均有统计学意义(P<0.05)。治疗后,与对照组比较,观察组血清CRP、WBC水平及APACHEⅡ评分和手术率均显著降低,差异均存在统计学意义(P<0.05)。与对照组对比,治疗后观察组B细胞、NK细胞和CD_3~+、CD_4~+、CD_8~+T细胞比例及CD_4~+/CD_8~+值均升高,但差异均无统计学意义(P>0.05)。结论:重症急性胰腺炎并发脓毒血症患者应用抗凝治疗,其临床疗效较肯定,但对免疫功能可能无显著影响。
Objective: To study the clinical effects of anticoagulant therapy in patients with severe acute pancreatitis complicated with sepsis and its effect on immune function. Methods: Seventy patients of severe acute pancreatitis complicated with sepsis were selected and divided into observation group and control group by random number table, with 35 in each group. Both groups received symptomatic treatment, and the observation group received low-molecular heparin sodium in addition. The treatment efficacies of the two groups were compared Results: A total of 66 patients completed the clinical study, including 34 in the observation group and 35 in the control group. The numbers of patients showing excellent efficacy, effectiveness or no effect were 31, 3 and 0 respectively in the observation group, while those in the control group were 22, 10 and 0, respectively. There were statistically significant differences in the rates of excellent efficacy and total clinical efficacy(P <0. 05). After treatment, the serum levels of CRP, WBC and APACHE 11 score and the percentage of patients receiving surgical operations in the observation group significantly decreased compared with the control group(P<0.05).The levels of B cells, T cells, NK cells, CD_3~+, CD_4~+, CD_8~+ and CD_4~+/CD_8~+ all increased, but the differences were not statistically significant(P >0. 05). Conclusion: Anticoagulant therapy has certain clinical efficacy for patients of severe acute pancreatitis complicated with sepsis, however, there may be no significant effect on immune function.
Objective: To study the clinical effects of anticoagulant therapy in patients with severe acute pancreatitis complicated with sepsis and its effect on immune function. Methods: Seventy patients of severe acute pancreatitis complicated with sepsis were selected and divided into observation group and control group by random number table, with 35 in each group. Both groups received symptomatic treatment, and the observation group received low-molecular heparin sodium in addition. The treatment efficacies of the two groups were compared Results: A total of 66 patients completed the clinical study, including 34 in the observation group and 35 in the control group. The numbers of patients showing excellent efficacy, effectiveness or no effect were 31, 3 and 0 respectively in the observation group, while those in the control group were 22, 10 and 0, respectively. There were statistically significant differences in the rates of excellent efficacy and total clinical efficacy(P <0. 05). After treatment, the serum levels of CRP, WBC and APACHE 11 score and the percentage of patients receiving surgical operations in the observation group significantly decreased compared with the control group(P<0.05).The levels of B cells, T cells, NK cells, CD_3~+, CD_4~+, CD_8~+ and CD_4~+/CD_8~+ all increased, but the differences were not statistically significant(P >0. 05). Conclusion: Anticoagulant therapy has certain clinical efficacy for patients of severe acute pancreatitis complicated with sepsis, however, there may be no significant effect on immune function.
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 M G, de Bruijn M T, Rutten J P, et al.Surgical intervention in patients with necroti-zing pancreatitis[J]. Br J Surg,2006, 93(5):593-599.
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[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, 5(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]黄强,李宓,杨薇薇,等.低分子肝素治疗重症急性胰腺炎的疗效分析[J].临床和实验医学杂志,2013, 12(18):1459-1461.
[9]焦华波,乔治,谭向龙,等.低分子肝素对急性胰腺炎患者预后的改善作用[J].中国危重病急救医学,2004, 12(16):712-714.
[10]马欢欢.低分子肝素治疗重症胰腺炎的疗效分析及对患者免疫功能的影响[J].中国社区医师杂志,2016, 32(30):99-100.
[11]Hunziker S, Celi L A, Lee J.Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients[J].Criti Cal Care, 2012,16(3):25-26.
[12]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].现代消化及介人诊疗,2017, 22(1):72-74.
[13]Angus D C, van der Poll T.Severe sepsis and septic shoc[J].N Engl J Med, 2013, 369(9):840-851.
[14]池春杰,王常松,李恩有.肝素在脓毒血症治疗中的临床研究现状[J].临床麻醉学杂志,2015, 31(7):719-720.
[15]吴志雄,罗正超,谭家余,等.低分子肝素钠治疗脓毒症患者30例分析[J].上海医药,2016, 37(1):36-12.
[16]朱建军.脓毒血症患者抗凝治疗对凝血和炎性指标的影响研究[J]临床医学工程,2016, 23(3):353-354.
[17]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.
[18]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.
[19]郭经华,聂祥碧,杨春丽,等.低分子肝素对脓毒症患者免疫功能的影响[J].江西医药,2014, 49(8):659-661.
[2]Besselink M G, de Bruijn M T, Rutten J P, et al.Surgical intervention in patients with necroti-zing 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病人的影响[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, 5(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]黄强,李宓,杨薇薇,等.低分子肝素治疗重症急性胰腺炎的疗效分析[J].临床和实验医学杂志,2013, 12(18):1459-1461.
[9]焦华波,乔治,谭向龙,等.低分子肝素对急性胰腺炎患者预后的改善作用[J].中国危重病急救医学,2004, 12(16):712-714.
[10]马欢欢.低分子肝素治疗重症胰腺炎的疗效分析及对患者免疫功能的影响[J].中国社区医师杂志,2016, 32(30):99-100.
[11]Hunziker S, Celi L A, Lee J.Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients[J].Criti Cal Care, 2012,16(3):25-26.
[12]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].现代消化及介人诊疗,2017, 22(1):72-74.
[13]Angus D C, van der Poll T.Severe sepsis and septic shoc[J].N Engl J Med, 2013, 369(9):840-851.
[14]池春杰,王常松,李恩有.肝素在脓毒血症治疗中的临床研究现状[J].临床麻醉学杂志,2015, 31(7):719-720.
[15]吴志雄,罗正超,谭家余,等.低分子肝素钠治疗脓毒症患者30例分析[J].上海医药,2016, 37(1):36-12.
[16]朱建军.脓毒血症患者抗凝治疗对凝血和炎性指标的影响研究[J]临床医学工程,2016, 23(3):353-354.
[17]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.
[18]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.
[19]郭经华,聂祥碧,杨春丽,等.低分子肝素对脓毒症患者免疫功能的影响[J].江西医药,2014, 49(8):659-661.