亚胺培南-西司他丁钠联合免疫球蛋白对婴儿脓毒症并发弥散性血管内凝血的疗效  

Effects of imipenem-cilastatin sodium combined with immunoglobulin on serum PCT,hs-CRP and TNF-α in children with baby sepsis complicated with disseminated intravascular coagulation

作　　者：茹彩旺 袁天明[1] 杨兵芬 吴福根 林应荣 莫妙军 RU Caiwang;YUAN Tianming;YANG Bingfen;WU Fugen;LIN Yingrong;MO Miaojun(Department of Neonatology,Children's Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310000,Zhejiang,China;Department of Neonatology,First People's Hospital of Wenling City,Wenling 317500,Zhejiang,China;Department of Pediatrics,First People's Hospital of Wenling City,Wenling 317500,Zhejiang,China;Department of Pediatrics,Wenling Maternal and Child Health Hospital,Wenling 317500,Zhejiang,China)

机构地区：[1]浙江大学医学院附属儿童医院新生儿科,浙江杭州310000 [2]温岭市第一人民医院新生儿科,浙江温岭317500 [3]温岭市第一人民医院儿科,浙江温岭317500 [4]温岭市妇幼保健院儿科,浙江温岭317500

出　　处：《中国临床药理学与治疗学》2020年第5期559-565,共7页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：浙江省基础公益研究计划项目(LGF18H150002)。

摘　　要：目的:探讨亚胺培南-西司他丁钠联合免疫球蛋白对婴儿脓毒症并发弥散性血管内凝血(DIC)患儿血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)及肿瘤坏死因子-α(TNF-α)的影响。方法:选择2013年1月至2019年4月本院收治的92例脓毒症并发DIC婴儿纳入研究,依随机数表法分观察组、对照组,各46例。对照组患儿采用亚胺培南-西司他丁钠治疗,观察组患儿给予亚胺培南-西司他丁钠联合免疫球蛋白治疗。对比两组疗效、DIC指标恢复正常、出血停止及重症护理病房(ICU)住院时间、凝血指标[纤维蛋白原(FIB)、血小板计数(PLT)、D-二聚体(D-D)、凝血酶时间(TT)]、血清炎症因子水平及不良反应发生率。结果:观察组患儿的治疗总有效率93.48%(43/46)高于对照组的78.26%(36/46),差异有统计学意义(P<0.05)。观察组患儿的DIC指标恢复正常时间、出血停止时间、ICU住院时间短于对照组,差异有统计学意义(P<0.05)。治疗5 d后两组患儿的血浆FIB、D-D、TT均降低,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗5 d后两组患儿血清PCT、hs-CRP、TNF-α表达均减少,观察组低于对照组,差异有统计学意义(P<0.05)。两组患儿用药不良反应发生率[2.17%(1/46)vs.6.52%(3/46)]对比差异无统计学意义(P>0.05)。结论:亚胺培南-西司他丁钠联合免疫球蛋白治疗婴儿脓毒症并发DIC疗效确切,能缓解或消除出血等症状,缩短ICU住院时间,改善凝血功能,减少血清PCT、hs-CRP及TNF-α表达,减轻机体炎症反应,且不良反应少,临床治疗价值高。AIM:To investigate the effects of imipenem-cilastatin sodium combined with immunoglobulin on serum PCT,hs-CRP and TNF-αin child with baby sepsis complicated with disseminated intravascular coagulation(DIC).METHODS:Nintytwo cases of patients with sepsis and DIC neonates admitted to our hospital from January 2013 to April 2019 were enrolled in this study.All the children were divided into observation group and control group according to random number table method,46 cases in each group.The patients in the control group were treated with imipenem-cilastatin sodium,and the patients in the observation group were treated with imipenem-cilastatin sodium combined with immunoglobulin.The efficacy of the two groups,the time of DIC index returned to normal,bleeding stopped and ICU hospitalization time,coagulation parameters(FIB,PLT,D-D,TT),serum inflammatory factor levels and incidence of adverse reactions were compared.RESULTS:The total effective rate of treatment in the observation group was93.48%(43/46),which was higher than that in the control group(78.26%,36/46)(P<0.05).The DIC index of the observation group returned to normal time,bleeding stop time,ICU hospitalization time was shorter than those of the control group(P<0.05).After 5 days of treatment,the plasma levels of FIB,D-D and TT were decreased in the two groups,and the observation group was lower than those of the control group,the difference was statistically significant(P<0.05).After 5 days of treatment,the expressions of serum PCT,hs-CRP and TNF-αwere decreased in the two groups,and the observation group was lower than the control group(P<0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups[2.17%(1/46)vs.6.52%(3/46)](P>0.05).CONCLUSION:Imipenem-cilastatin combined with immunoglobulin is effective in the treatment of baby sepsis complicated with DIC.It can alleviate or eliminate bleeding and other symptoms,shorten ICU hospitalization time,improve coagulation function,and reduce serum PCT and hsCRP,TNF-�

关 键 词：亚胺培南-西司他丁钠 免疫球蛋白 婴儿脓毒症 弥散性血管内凝血 血清炎症因子 

分 类 号：R631[医药卫生—外科学] R72[医药卫生—临床医学]