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  本文關鍵詞： 嚴重創(chuàng)傷 多器官功能障礙綜合征 血必凈　出處：《大連醫(yī)科大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：目前采用多種手段對MODS進行治療，，雖然取得了一定進展，但至今仍有較高的死亡率，治療費用高昂，其根本原因在于現(xiàn)階段無法有效抑制MODS病理發(fā)展過程，雖然采用各種先進方法使患者生命得到延長，但愈后改變不盡人意，病死率居高不下，且病死率隨功能衰竭器官的數(shù)目增加而增加，因此，探索更為有效的防治手段以改善該種病人的預后和生活質量已經(jīng)成為危重病領域重點研究課題。MODS患者的微循環(huán)障礙、血液瘀滯、血流不暢等是其重要的病理生理變化，為中醫(yī)藥活血化瘀法治療MODS提供了主要依據(jù)。 本研究通過觀察血必凈治療組與對照組病人臨床轉歸情況，明確血必凈注射液是否可以縮短并發(fā)多器官功能障礙綜合征患者的病程、改善相關癥狀、防止已經(jīng)受累的器官功能障礙進一步加重，保護尚未受累及的器官，以及是否有明顯的毒副作用。為臨床治療嚴重外傷并發(fā)多器官功能障礙綜合征提供有益的借鑒。 方法：采用多中心、隨機、平行對照分組方法，對由嚴重創(chuàng)傷導致的多器官功能障礙綜合征病例進行觀察。治療組和對照組均選擇針對患者最佳的個體化治療方案，確保患者的安全，并不會因臨床研究而加重對患者身體的損害。治療組在個體化治療基礎上加血必凈注射液，觀察治療后患者的反應，觀察指標選擇在MODS中最易受累及的循環(huán)、呼吸、血液系統(tǒng)。循環(huán)方面的功能：觀察血必凈治療后平均動脈壓、尿量是否增加，心率是否下降，與對照組比較是否有統(tǒng)計學意義；呼吸方面的功能：觀察氧合指數(shù)是否升高，呼吸頻率是否下降，與對照組比較是否有統(tǒng)計學意義；血液方面：觀察血小板是否升高，與對照組比較是否有統(tǒng)計學意義；綜合方面：受累器官評分是否增加，與對照組比較是否有統(tǒng)計學意義。 結果：按臨床控制、顯效、無效、死亡進行評定。血必凈注射液治療組控顯率達到88.46％，對照組控顯率為70.83％，兩組經(jīng)統(tǒng)計學比較，有顯著性差異，P0.05。 結論：血必凈注射液可以輔助治療由多發(fā)創(chuàng)傷等引起的多器官功能障礙綜合征，在呼吸、循環(huán)及凝血方面較對照組有明顯改善，提高平均動脈壓、增加尿量、改善氧合、改善凝血，縮短病程，改善相關癥狀，防止受累器官功能障礙進一步加重，保護未受累的器官。臨床試驗中未發(fā)現(xiàn)明顯的毒副作用。
[Abstract]:Objective: although some progress has been made in the treatment of MODS by various methods, there is still a high mortality rate and the cost of treatment is high. The fundamental reason lies in the fact that the pathological development of MODS can not be effectively inhibited at this stage. Although various advanced methods are used to prolong the life of patients, the changes after recovery are unsatisfactory and the fatality rate remains high. The mortality increased with the increase of the number of organs of functional failure. To explore more effective prevention and treatment methods to improve the prognosis and quality of life of this kind of patients has become a critical research topic in the field of critical diseases .mods patients with microcirculation disorders, blood stasis. Blood flow obstruction is an important pathophysiological change, which provides the main basis for the treatment of MODS by activating blood circulation and removing blood stasis. By observing the clinical outcome of patients in Xuebijing treatment group and control group, it is clear whether Xuebijing injection can shorten the course of disease and improve the related symptoms in patients with multiple organ dysfunction syndrome. To prevent the dysfunction of the affected organs from becoming more serious and to protect the unaffected organs. And whether there are obvious side effects. It provides a useful reference for the clinical treatment of severe trauma complicated with multiple organ dysfunction syndrome. Methods: a multicenter, randomized, parallel control group was used. The patients with multiple organ dysfunction syndrome caused by severe trauma were observed. Both the treatment group and the control group chose the best individualized treatment for patients to ensure the safety of patients. Treatment group on the basis of individualized treatment plus Xuebijing injection to observe the response of patients after treatment. The function of circulation, respiration and blood system in MODS: observe the mean arterial pressure, urine volume and heart rate after Xuebijing treatment. Compared with the control group, there was statistical significance. Respiratory function: observe whether oxygenation index is increased, respiratory frequency is decreased, compared with the control group, whether there is statistical significance; Blood: observe whether the platelet is elevated, compared with the control group, whether there is statistical significance; Comprehensive aspects: whether the score of affected organs increased, and whether there was statistical significance compared with the control group. Results: according to clinical control, remarkable effect, ineffective, death evaluation. Xuebijing injection treatment group control rate reached 88.46 and the control group control rate was 70.83, the two groups were compared statistically. There was significant difference (P 0.05). Conclusion: Xuebijing injection can be used to treat multiple organ dysfunction syndrome caused by multiple trauma. Compared with the control group, Xuebijing injection can improve respiration, circulation and coagulation, increase mean arterial pressure and increase urine volume. It can improve oxygenation, improve coagulation, shorten the course of disease, improve the related symptoms, prevent the dysfunction of the involved organs from further aggravation, and protect the unaffected organs. No obvious toxic side effects were found in the clinical trials.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R459.7

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