本文關鍵詞： 血必凈注射液 膿毒性休克 凝血功能 炎癥因子　出處：《河北醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:膿毒癥(Sepsis)是由炎癥感染引起的臨床重癥[1],膿毒性休克(Septic shock)是由炎癥引起的全身嚴重炎癥反應和(或)器官障礙的綜合征,又叫感染性休克[2],機體感染時大量白介素、腫瘤壞死因子等炎癥因子合成、釋放入血液或體液中,血管內皮功能損傷導致血管通透性急劇增加,凝血因子Ⅻ從而被活化,啟動內源性凝血系統(tǒng),血液濃縮,微血管內形成微血栓,導致微循環(huán)障礙,各種因素相互促進、影響,嚴重時誘發(fā)多器官衰竭(MODS)[3]。研究發(fā)現(xiàn),膿毒癥死亡率與凝血功能異常程度呈正相關性[4]。血必凈注射液能清除內毒素、白介素、腫瘤壞死因子等炎癥因子,改善細胞缺氧,具有活血化瘀、清熱解毒之功效[5],同時還具有增強體液免疫功能的作用[6]。本研究采用血必凈注射液治療膿毒性休克,觀察其炎癥因子、乳酸水平及凝血功能變化,探討血必凈注射液對膿毒性休克的臨床治療作用。方法:所有患者均按照指南要求進行液體復蘇、血管活性藥物、合理抗生素、強化胰島素、保護肝腎功能、預防應激性潰瘍、營養(yǎng)支持等治療[7],干預組在對照組基礎上加用血必凈注射液,每日2次,療程為一周。兩組患者分別于治療前、治療1d、3d、7d、14d后抽血測定血乳酸、凝血酶原時間、活化部分凝血活酶時間、血小板計數(shù)及TNF-α、IL-1、IL-6水平變化。凝血酶原時間、活化部分凝血活酶時間采用日本Sysmex CA7000全自動凝血分析儀。血小板計數(shù)采用全自動五分類血液細胞分析儀測定。TNF-α、IL-1、IL-6采用酶聯(lián)免疫吸附法測定。結果:1兩組一般情況比較:對照組25例,其中男性11例,女性14例,年齡33-65歲,平均年齡59.23±10.69歲,體重69.29±12.25kg,其中高血壓5例、冠心病8例、高脂血癥12例、腦梗死后遺癥3例;干預組25例,其中男性13例,女性12例,年齡30-64歲,平均年齡59.23±11.34歲,體重72.34±12.50kg,其中高血壓6例、冠心病7例、高脂血癥10例、腦梗死后遺癥5例。兩組患者一般情況比較差異均無統(tǒng)計學意義。2兩組凝血功能比較:治療前、治療第1天、第3天兩組患者PT、APTT比較差異無統(tǒng)計學意義。治療第7天、第14天,干預組患者PT、APTT比對照組明顯縮短(P0.05)。3兩組血小板比較:治療前、治療第1天、第3天兩組患者血小板計數(shù)比較差異無統(tǒng)計學意義。治療第7、14天干預組血小板計數(shù)比對照組明顯升高(P0.05)。治療前后兩組同組比較差異有統(tǒng)計學意義(F對照組=60.262,P0.05;F干預組=119.414,P0.05),治療第7、14天,兩組血小板計數(shù)均較治療前升高(P0.05)。4兩組血乳酸水平比較:治療前后兩組患者血乳酸水平比較差異無統(tǒng)計學意義。兩組治療前后同組比較差異有統(tǒng)計學意義(F對照組=76.973,P0.05;F干預組=82.004,P0.05),治療第1天、3天、7天、14天兩組患者血乳酸水平均較治療前下降。5兩組TNF-α、IL-1、IL-6水平比較:治療前、治療第1天兩組患者TNF-α、IL-1、IL-6水平比較差異無統(tǒng)計學意義。治療第3天、7天、14天,干預組TNF-α、IL-1、IL-6水平低于對照組(P0.05)。干預組治療前后比較有統(tǒng)計學意義(FTNF-α=104.952,P0.05;FIL-1=437.422,P0.05;FIL-6=887.459,P0.05),第7天比第3天TNF-α、IL-1、IL-6水平降低,第14天比第7天TNF-α、IL-1、IL-6水平降低(P0.05)。6兩組14天病死率比較:干預組總病死率稍低于對照組,但兩組差異無統(tǒng)計學意義。結論:1血必凈注射液能改善膿毒性休克患者凝血功能(PT、APTT縮短),可能在某種程度上提高血小板數(shù)量。2血必凈注射液能明顯降低血清TNF-α、IL-1、IL-6表達水平。3血必凈注射液不能改善膿毒性休克患者病死率。
[Abstract]:Objective: sepsis (Sepsis) is caused by severe clinical [1] infection, septic shock (Septic shock) is caused by inflammation, severe systemic inflammation and organ dysfunction syndrome (or), also called septic shock [2] infection a lot of interleukin, tumor necrosis factor and inflammation cytokine synthesis, release into the blood or body fluids, vascular endothelial function injury induced vascular permeability increased dramatically, Hageman factor can be activated, start the blood coagulation system, endogenous blood concentration, microvascular microthrombus, lead to microcirculation obstacle factors to promote each other and influence, serious when induced multiple organ failure (MODS) [3]. the study found that the mortality rate of sepsis and abnormal coagulation function were positively correlation between [4]. of Xuebijing injection to remove endotoxin, interleukin, tumor necrosis factor and other inflammatory factors, improve hypoxia, with blood stasis, clearing Heat and toxic substances [5], [6]. also has the enhancement of humoral immune function in this study by Xuebijing injection in the treatment of septic shock, to observe the changes of inflammatory cytokines, lactic acid and blood coagulation function, clinical treatment of Xuebijing Injection on septic shock were used. Method: all the patients were in accordance with the guidelines for fluid resuscitation, vasoactive drugs, antibiotics, insulin, liver and renal function, prevention of stress ulcer, nutritional support treatment [7], intervention group on the basis of the control group and Xuebijing injection, 2 times a day, lasted for a week. Two groups of patients before treatment, treatment of 1D, 3D, 7d, 14d blood serum lactic acid, prothrombin time, activated partial thromboplastin time, platelet count and serum TNF-, IL-1, IL-6 level changes. Prothrombin time, activated partial thromboplastin time by Japan Sysmex CA7 000 Automatic Coagulation Analyzer. The determination of.TNF- alpha, automatic five classification blood cell analyzer using platelet count IL-1, IL-6 was measured by ELISA. Results: compared with two groups of 1 general situation: 25 cases in the control group, there were 11 males and 14 females, aged 33-65 years, mean age 59.23 + 10.69 years old, weight 69.29 + 12.25kg, including 5 cases of hypertension, 8 cases of coronary heart disease, 12 cases of hyperlipidemia, 3 cases of sequelae of cerebral infarction; 25 cases in the intervention group, there were 13 males and 12 females, aged 30-64 years, mean age 59.23 + 11.34 years old, weighing 72.34 12.50kg, including 6 cases of hypertension, 7 cases of coronary heart disease, 10 cases of hyperlipidemia, 5 cases of sequelae of cerebral infarction. In general the two groups the difference was not statistically significant.2 blood coagulation function in two groups compared with that before treatment, treatment for first days, third days, two groups of patients with PT, APTT had no significant difference. For seventh days, fourteenth days, patients in the intervention group PT, APTT was significantly shorter than the control group (P0.05).3 two groups: before treatment, treatment for first days, third days was not statistically significant compared two groups of patients with platelet count difference. Treatment of 7,14. The pre group platelet count than the control group increased significantly (P0.05). There was statistical significance between the two groups before and after treatment in the same group the difference (F P0.05; F =60.262 in control group, intervention group =119.414, P0.05), treatment 7,14 days, two groups of platelet count were significantly higher than before treatment (P0.05) between.4 two group blood lactate levels: the two groups of patients with blood lactate levels before and after treatment, the difference was not statistically significant. Compared with the two groups before and after treatment the difference was statistically significant (=76.973 P0.05; F control group, F intervention group =82.004, P0.05), for first days, 3 days, 7 days, 14 days, two groups of patients with blood lactate levels were lower than that before treatment in two groups of.5 IL-1, TNF- alpha, IL-6 level compared with that before treatment, first days of treatment in two groups TN IL-1, F- alpha, IL-6 level had no significant difference. For third days, 7 days, 14 days, the intervention group of TNF- alpha, IL-1, IL-6 levels lower than the control group (P0.05). The intervention group before and after treatment were statistically significant (FTNF- alpha =104.952, P0.05; FIL-1=437.422, P0.05; FIL-6= 887.459, P0.05). Seventh days more than third days of TNF- alpha, IL-1, lower the level of IL-6, fourteenth days more than seventh days of TNF- alpha, IL-1, lower the level of IL-6 (P0.05).6 two group in the 14 day mortality rate comparison: the intervention group total mortality rate was slightly lower than the control group, but no significant differences between the two groups. Conclusion: 1 the blood will net injection can improve the coagulation function in septic patients (PT, APTT, platelet count shorten) may improve the.2 of Xuebijing injection in some extent could significantly decrease the serum levels of TNF-, IL-1, IL-6 expression level of.3 in Xuebijing injection can not improve the mortality in patients with septic shock.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R459.7

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