發(fā)布時間：2018-03-13 02:22

  本文選題：膿毒癥　切入點：肝損傷　出處：《大連醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本研究是通過觀察前列地爾(ALPROSTADIL PGE1)對膿毒癥所導致的急性肝損傷患者肝功能(谷丙轉氨酶ALT、谷草轉氨酶AST),肝臟排泄功能(總膽紅素STB、直接膽紅素CB),APACHEⅡ評分,血清TNF-α、血清沉默信號調節(jié)因子蛋白1(Sirt1)表達水平影響及變化,并進一步研究和探討前列地爾對膿毒癥急性肝損傷患者炎癥反應及肝臟功能的影響。方法:本研究選取了2016年01月-2016年12月間入住大連醫(yī)科大學附屬第二醫(yī)院中心ICU內80例膿毒癥急性肝損傷患者,其年齡分布在50-90歲,隨機分為PGE1治療組(A組,n=40)和標準抗膿毒癥治療組(B組,n=40)。入選的全部膿毒癥急性肝損傷患者均給以標準規(guī)范的藥物抗膿毒癥治治療(sepsis3.0標準)以及液體復蘇,A組在此基礎上同時予以PEG1 10ug(加入生理鹽水10ml)治療,12小時一次,持續(xù)1周治療;應用藥物后再分別監(jiān)測兩組患者治療前及治療后第1、3、5、7天患者血谷丙轉氨酶ALT、谷草轉氨酶AST、總膽紅素STB、直接膽紅素CB、APACHEⅡ評分、血清TNF-α、血清沉默信號調節(jié)因子蛋白1(Sirt1)。采用SPSS21.0軟件包統(tǒng)計學軟件對本研究結果進行統(tǒng)計學分析。并對治療前后組內患者ALT、AST、STB、CB、APACHEⅡ評分、血清TNF-α、血清沉默信號調節(jié)因子蛋白1(Sirt1)各時間點數(shù)據(jù)采用均數(shù)標準差表示,p0.05表示差異有統(tǒng)計學意義。結果: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較入科時明顯下降,有統(tǒng)計學意義(P0.05);B組患者未應用前列地爾治療,血清ALT、血清AST在治療后第1、3天ALT均較入科時升高(P0.05),第7天ALT、AST較入科時下降(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較入科時明顯下降,有統(tǒng)計學意義(P0.05);B組患者血STB、血CB在治療后第1、3天AST均較入科時升高(P0.05),第7天血STB、血CB較入科時下降,有統(tǒng)計學意義(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評分在治療后第5天、第7天較治療前明顯下降,與入科時差異具有統(tǒng)計學意義(P0.05);B組APACHEⅡ評分在治療后第7天APACHEⅡ評分較治療前下降(P0.05),與入科時差異具有統(tǒng)計學意義(P0.05)。A組APACHEⅡ評分在治療后的第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,與入科時差異具有統(tǒng)計學意義(p0.05),治療后第3天、第5天、7天較治療前明顯升高,與入科時差異具有統(tǒng)計學意義(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,與入科時差異具有統(tǒng)計學意義(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,與入科時差異具有統(tǒng)計學意義(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,與入科時差異具有統(tǒng)計學意義(p0.05)。但A組患者應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)。結論:前列地爾能夠促進膿毒癥所致急性肝損傷患者肝功能恢復,減輕膿毒癥時的炎癥反應,減輕肝臟損傷,促進患者肝功能恢復。
[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：1604390