本文選題：膿毒癥 + 彌散性血管內(nèi)凝血　； 參考：《首都醫(yī)科大學(xué)》2017年碩士論文

【摘要】：研究目的:膿毒癥及其相關(guān)并發(fā)癥的診斷及治療一直是臨床上比較棘手的問題。目前關(guān)于血栓調(diào)節(jié)蛋白治療膿毒癥合并彌散性血管內(nèi)凝血(Disseminated Intravascular Coagulation,DIC)成為了研究熱點,但就現(xiàn)在國際上已經(jīng)發(fā)表的眾多研究來看,究竟其是否可以降低患者死亡率還尚無定論。因此,我們系統(tǒng)回顧并分析了國內(nèi)外相關(guān)臨床研究來綜合評價血栓調(diào)節(jié)蛋白(thrombomodulin,TM)對于膿毒癥繼發(fā)DIC患者的療效。研究方法:我們在Pub Med,Web of Science,Embase及Cochrane Library數(shù)據(jù)庫中仔細搜索了2017年3月以前所有符合納入標(biāo)準的相關(guān)文章,并提取文章中重要數(shù)據(jù),主要對各個研究中患者的28天或30天死亡率進行評估比較。研究結(jié)果:我們最終共納入了3篇隨機對照研究及10篇觀察性研究,共計18380個膿毒癥合并DIC患者(隨機對照研究組共913人,觀察性研究組共17467人),各研究中實驗組患者均接受重組人可溶性血栓調(diào)節(jié)蛋白(Recombinant human soluble thrombomodulin,rh TM)的治療。分析結(jié)果顯示:在隨機對照組,患者28天或者30天死亡率的相對危險度(Relative risk,RR)值為0.83(95%可信區(qū)間,0.64-1.07);觀察性研究組中RR值為0.96(95%可信區(qū)間,0.92-1.01)。在嚴重出血事件方面,實驗組和對照組并沒有顯著差異。結(jié)論:根據(jù)目前現(xiàn)有的研究結(jié)果來看,與其他抗凝劑治療效果相比較,rh TM并不能顯著降低患者短期死亡率,但同時也需要更多高質(zhì)量的臨床研究來進一步證實該結(jié)論。
[Abstract]:Objective: the diagnosis and treatment of sepsis and its related complications has been a difficult problem in clinic. At present, thrombomodulin has become a hot topic in the treatment of sepsis with disseminated intravascular coagulation (Intravascular Coagulation). However, it is still unclear whether thrombomodulin can reduce the mortality rate of patients with sepsis. Therefore, we systematically reviewed and analyzed the clinical studies at home and abroad to evaluate the efficacy of thrombomodulin in patients with DIC secondary to sepsis. Research methods: we searched the Pub MedWeb of Science Embase and Cochrane Library databases for all relevant articles that meet the inclusion criteria by March 2017, and extracted important data from the articles. The 28-day or 30-day mortality rates in each study were evaluated and compared. Results: we eventually included 3 randomized controlled trials and 10 observational studies, with a total of 18 380 septic patients with DIC. 17467 patients in the observational study group were treated with recombinant human soluble thrombomodulin human soluble (Recombinant human soluble thrombomodulin rh TMH). The results showed that in the randomized control group, the relative risk of mortality on day 28 or 30 was 0.83V 95% CI 0.64-1.07g, and the RR in the observational study group was 0.9695% CI 0.92-1.01g. There was no significant difference between the experimental group and the control group in severe bleeding events. Conclusion: compared with other anticoagulants, rh TM can not significantly reduce the short-term mortality rate, but more high quality clinical studies are needed to further confirm this conclusion.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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