發(fā)布時(shí)間：2018-03-13 02:22

  本文選題：膿毒癥　切入點(diǎn)：肝損傷　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:本研究是通過(guò)觀(guān)察前列地爾(ALPROSTADIL PGE1)對(duì)膿毒癥所導(dǎo)致的急性肝損傷患者肝功能(谷丙轉(zhuǎn)氨酶ALT、谷草轉(zhuǎn)氨酶AST),肝臟排泄功能(總膽紅素STB、直接膽紅素CB),APACHEⅡ評(píng)分,血清TNF-α、血清沉默信號(hào)調(diào)節(jié)因子蛋白1(Sirt1)表達(dá)水平影響及變化,并進(jìn)一步研究和探討前列地爾對(duì)膿毒癥急性肝損傷患者炎癥反應(yīng)及肝臟功能的影響。方法:本研究選取了2016年01月-2016年12月間入住大連醫(yī)科大學(xué)附屬第二醫(yī)院中心ICU內(nèi)80例膿毒癥急性肝損傷患者,其年齡分布在50-90歲,隨機(jī)分為PGE1治療組(A組,n=40)和標(biāo)準(zhǔn)抗膿毒癥治療組(B組,n=40)。入選的全部膿毒癥急性肝損傷患者均給以標(biāo)準(zhǔn)規(guī)范的藥物抗膿毒癥治治療(sepsis3.0標(biāo)準(zhǔn))以及液體復(fù)蘇,A組在此基礎(chǔ)上同時(shí)予以PEG1 10ug(加入生理鹽水10ml)治療,12小時(shí)一次,持續(xù)1周治療;應(yīng)用藥物后再分別監(jiān)測(cè)兩組患者治療前及治療后第1、3、5、7天患者血谷丙轉(zhuǎn)氨酶ALT、谷草轉(zhuǎn)氨酶AST、總膽紅素STB、直接膽紅素CB、APACHEⅡ評(píng)分、血清TNF-α、血清沉默信號(hào)調(diào)節(jié)因子蛋白1(Sirt1)。采用SPSS21.0軟件包統(tǒng)計(jì)學(xué)軟件對(duì)本研究結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。并對(duì)治療前后組內(nèi)患者ALT、AST、STB、CB、APACHEⅡ評(píng)分、血清TNF-α、血清沉默信號(hào)調(diào)節(jié)因子蛋白1(Sirt1)各時(shí)間點(diǎn)數(shù)據(jù)采用均數(shù)標(biāo)準(zhǔn)差表示,p0.05表示差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:A組血清ALT、血清AST在治療后第1天較治療前上升,第3天患者ALT、AST較前下降(P0.05),患者第5、7天ALT、AST較入科時(shí)明顯下降,有統(tǒng)計(jì)學(xué)意義(P0.05);B組患者未應(yīng)用前列地爾治療,血清ALT、血清AST在治療后第1、3天ALT均較入科時(shí)升高(P0.05),第7天ALT、AST較入科時(shí)下降(P0.05)。A組血清ALT、血清AST水平在治療后的第5、7天均低于B組同期水平(P0.05)。A組血STB、血CB在治療后第1天較治療前上升(P0.05),第3天患者STB、CB較前下降(P0.05),患者第5、7天STB、CB較入科時(shí)明顯下降,有統(tǒng)計(jì)學(xué)意義(P0.05);B組患者血STB、血CB在治療后第1、3天AST均較入科時(shí)升高(P0.05),第7天血STB、血CB較入科時(shí)下降,有統(tǒng)計(jì)學(xué)意義(P0.05)。A組血STB、血CB水平在治療后的第3天、第5天、第7天均低于B組同期水平(P0.05)。A組患者APACHEⅡ評(píng)分在治療后第5天、第7天較治療前明顯下降,與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(P0.05);B組APACHEⅡ評(píng)分在治療后第7天APACHEⅡ評(píng)分較治療前下降(P0.05),與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。A組APACHEⅡ評(píng)分在治療后的第3天、第5天、第7天均低于B組同期水平(P0.05)。A組Sirt1濃度治療后第1天較治療前下降,與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(p0.05),治療后第3天、第5天、7天較治療前明顯升高,與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(p0.05);B組Sirt1濃度治療后第1天較治療前下降,(p0.05),第3天較治療前升高,(P0.05),第5天、7天較治療前明顯升高,與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。但A組治療后在第3、5、7天Sirt1濃度均高于于同期B組水平(p0.05)。A組TNF-α濃度治療后第1天較治療前明顯升高(p0.05),治療后第5天、7天較治療前明顯下降,與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(p0.05);B組TNF-α濃度治療后第1天較治療前明顯升高(p0.05),第5、7天較治療前下降,與入科時(shí)差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。但A組患者應(yīng)用前列地爾治療后在第1、3、5、7天TNF-α濃度均低于同期B組水平(p0.05)。結(jié)論:前列地爾能夠促進(jìn)膿毒癥所致急性肝損傷患者肝功能恢復(fù),減輕膿毒癥時(shí)的炎癥反應(yīng),減輕肝臟損傷,促進(jìn)患者肝功能恢復(fù)。
[Abstract]:Objective: the purpose of this study is through the observation of alprostadil (ALPROSTADIL PGE1) in patients with liver function caused by acute liver injury on sepsis (alanine aminotransferase ALT and aspartate aminotransferase (AST), hepatic excretion function of total bilirubin direct bilirubin, STB, CB) APACHE score, serum TNF-, serum silence signal regulator 1 (Sirt1) expression level change and influence, and further research and discussion of alprostadil inflammation and liver function of patients with sepsis with acute liver injury. Methods: This study selected from December 2016 01 months -2016 years in the Second Affiliated Hospital of Dalian Medical University center ICU in 80 cases of acute liver injury in patients with sepsis the age distribution, at the age of 50-90, were randomly divided into PGE1 treatment group (group A, n=40) and standard anti sepsis treatment group (group B, n=40). All acute liver injury in patients with sepsis sepsis were selected by the Standard Specification for drugs against sepsis Sepsis treatment (sepsis3.0) and fluid resuscitation, A group based on PEG1 10ug (also be added 10ml saline) for 12 hours, 1 weeks of treatment; application of drugs respectively after the two groups were monitored before and after treatment 1,3,5,7 days in patients with serum alanine aminotransferase ALT aspartate AST STB, total bilirubin, direct bilirubin, CB, APACHE score, serum TNF-, serum silence signal regulating factor protein 1 (Sirt1). Statistical software package for the results of this study were analyzed by SPSS21.0 software. And the patients before and after treatment in group ALT, AST, STB, CB, APACHE score. Serum TNF-, serum silence signal regulating factor protein 1 (Sirt1) at each time point data using mean standard deviation, P0.05 said the difference was statistically significant. Results: the serum ALT of A group, the serum AST in first days after treatment compared with those before treatment, third days in patients with ALT, A ST杈冨墠涓嬮檷(P0.05),鎮(zhèn)ｈ，

本文編號(hào)：1604390