本文關(guān)鍵詞： 膿毒癥 菌毒炎并治 涼膈散 血必凈注射液 臨床療效　出處：《天津醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本課題旨在觀察膿毒癥患者的生命體征、炎癥反應(yīng)參數(shù)、凝血功能指標(biāo)、APACHEII評分、中醫(yī)癥狀評分、胃腸功能障礙發(fā)生率、14及28天生存率等作為臨床療效評價指標(biāo),對照觀察“菌毒炎并治”的治療方案對膿毒癥患者的臨床療效,為膿毒癥治療方案的進(jìn)一步優(yōu)化提供有益的幫助。方法:采用前瞻性、隨機(jī)、對照的實(shí)驗(yàn)設(shè)計(jì)方法,選取2014年3月至2015年7月符合納入標(biāo)準(zhǔn)的患者50例,利用隨機(jī)數(shù)字表法將患者隨機(jī)劃分為治療組和對照組。對照組給予一般西醫(yī)基礎(chǔ)治療(參照《2012年國際膿毒癥及膿毒癥休克治療指南》,包括早期廣譜抗生素、液體復(fù)蘇、預(yù)防應(yīng)激性潰瘍、控制血糖、臟器支持和基礎(chǔ)病因治療等)和血必凈注射液50ml,靜脈點(diǎn)滴,每日2次,療程7天。治療組在對照組治療基礎(chǔ)之上加用涼膈散顆粒劑150ml,口服或鼻飼,每日2次,療程7天。于入組當(dāng)天、給藥后第3天、第7天或死亡前,分別觀察患者相關(guān)癥狀體征,檢測血常規(guī)、血?dú)夥治�、凝血全�?xiàng)、C反應(yīng)蛋白、降鈣素原、TNF-a、IL-1β、IL-10并進(jìn)行APACHE-II評分、DIC評分,隨訪14天、28天生存率。結(jié)果:1在炎癥反應(yīng)指標(biāo)方面,治療組的體溫降低幅度相對于對照組更為明顯,差異具有統(tǒng)計(jì)學(xué)意義(P0.05),治療組WBC、PCT、TNF-a水平較對照組比較明顯下降(P0.05),而治療組IL-10水平較治療前明顯升高(P0.05)。2在凝血功能指標(biāo)方面,治療組APTT未見明顯延長,對照組治療第7天APTT較治療前明顯延長,差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療組治療第3天D-二聚體水平明顯降低,與對照組比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);治療組第7天PLT明顯升高,與對照組比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);治療組第7d天DIC評分比治療前下降,和對照組相比差異顯著,體現(xiàn)出統(tǒng)計(jì)學(xué)意義(P0.05)。3對照組和治療組APECHE-II評分與治療前比較均有所下降,治療組第7天較治療前下降明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05);經(jīng)治療兩組患者第3、7天中醫(yī)癥候積分均較治療前顯著下降(P0.01),治療組患者第7天中醫(yī)癥候積分相對于對照組顯著下降,差異體現(xiàn)統(tǒng)計(jì)學(xué)意義(P0.01);兩組比較綜合療效,對照組與治療組有效率分別為20%和60%;兩組比較有效率,治療組明顯高于對照組,差異體現(xiàn)統(tǒng)計(jì)學(xué)意義(P0.05)。4對照組與治療組第14天死亡率分別為24%和16%,28天死亡率分別為32%和24%,兩組比較差異亦無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:“菌毒炎并治”治療方案對降低高熱膿毒癥患者體溫更有效,降低WBC、PCT、CRP水平,能夠更好的降低患者體內(nèi)TNF-a的濃度,從源頭上抑制“炎癥瀑布反應(yīng)”的發(fā)生,能夠促進(jìn)IL-10的釋放,抑制炎癥介質(zhì)的產(chǎn)生,從而來調(diào)節(jié)促炎和抗炎反應(yīng)的動態(tài)平衡,有助于全身炎癥反應(yīng)的控制。該治療方案還能夠改善部分凝血功能指標(biāo),阻斷膿毒癥繼發(fā)性纖溶亢進(jìn)和纖維蛋白原的消耗,改善膿毒癥凝血功能障礙,促進(jìn)膿毒癥患者病情好轉(zhuǎn),在一定程度上改善患者預(yù)后,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to observe the vital signs, inflammatory parameters, coagulation function index and Apache II score, TCM symptom score and incidence rate of gastrointestinal dysfunction in patients with sepsis. The 14 and 28 days survival rate was used as the clinical curative effect evaluation index, the clinical curative effect of "Bacteritis combined with treatment" in patients with sepsis was observed. Methods: prospective, randomized and controlled experimental design was used. From March 2014 to July 2015, 50 patients who met the inclusion criteria were selected. Patients were randomly divided into treatment group and control group by random digital table. The control group was given general western medicine basic treatment (reference < 2012 International guidelines for treatment of sepsis and sepsis shock). These include early broad-spectrum antibiotics, fluid resuscitation, prevention of stress ulcers, control of blood glucose, organ support and basic etiology therapy) and Xuebijing injection 50 ml, intravenous drip twice a day. The treatment group was treated with Liangge Powder (150ml), orally or by nasal feeding, twice a day for 7 days. On the day of treatment, on the third day, the 7th day or before death, the treatment group was treated with Liangge Powder in addition to the control group. The symptoms and signs of the patients were observed, blood routine examination, blood gas analysis, blood clotting all of C reactive protein, procalcitonin TNF-a IL-1 尾 were observed. IL-10 was followed up with APACHE-II score and the survival rate was 28 days after 14 days follow-up. Results: 1 was involved in inflammatory response index. The decrease of body temperature in the treatment group was more obvious than that in the control group, and the difference was statistically significant (P 0.05). The level of TNF-a was significantly lower than that of the control group (P 0.05), while the level of IL-10 in the treatment group was significantly higher than that before treatment. The APTT of the treatment group was not significantly prolonged, and the APTT of the control group was significantly longer on the 7th day than that before treatment (P 0.05). On the 3rd day of treatment, the level of D- dimer in the treatment group was significantly lower than that in the control group (P 0.05). On the 7th day, the PLT in the treatment group was significantly higher than that in the control group (P 0.05). On the 7th day, the DIC score of the treatment group was lower than that of the control group, and there was a significant difference between the treatment group and the control group. The APECHE-II scores of the control group and the treatment group were lower than that of before treatment, and the APECHE-II score of the treatment group on the 7th day was significantly lower than that before treatment. The difference was statistically significant (P 0.05). The scores of TCM symptoms on the 3rd day after treatment were significantly lower than those before treatment, and the scores of TCM symptoms on the 7th day in the treatment group were significantly lower than those in the control group. The difference was statistically significant (P 0.01). The effective rates of control group and treatment group were 20% and 60 respectively. The effective rate of the two groups was significantly higher than that of the control group, the difference was statistically significant (P 0.05). 4 the mortality of the control group and the treatment group on the 14th day were 24% and 16% respectively. The death rates of 28 days were 32% and 24, respectively, and there was no significant difference between the two groups (P 0.05). Conclusion: the treatment of "Bacteritis combined with treatment" is more effective in reducing the body temperature of patients with hyperpyretic sepsis. Reducing the level of TNF-a in patients can reduce the concentration of TNF-a, inhibit the occurrence of "inflammatory waterfall" from the source, and promote the release of IL-10. Inhibit the production of inflammatory mediators, thereby regulating the dynamic balance of pro-inflammatory and anti-inflammatory response, which is helpful to the control of systemic inflammatory response. Blocking the secondary hyperfibrinolysis and the consumption of fibrinogen in sepsis, improving the coagulation dysfunction of sepsis, promoting the improvement of the condition of sepsis, improving the prognosis of the patients to a certain extent, is worthy of clinical application.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R459.7
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本文編號：1470091