联合使用维生素C、维生素B1及氢化可的松对脓毒症血小板减少症患者疗效的影响  

Clinical efficacy of combination of vitamin C,thiamine and hydrocortisone in treatment of septic patients with thrombocytopenia

作　　者：杨蕊 蒋佳维 王勇强[1] Yang Rui;Jiang Jiawei;Wang Yongqiang(Department of Critical Care Medicine,Tianjin First Center Hospital,Tianjin.Institute of Emergency Medicine,Tianjin 300192,China;the First.Center Clinical College,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津市第一中心医院重症医学科,天津市急救研究所,天津300192 [2]天津医科大学一中心临床学院,天津300070

出　　处：《中国中西医结合急救杂志》2021年第1期48-51,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家临床重点专科建设项目(2011-873);天津市卫生行业重点攻关项目(14KG101);天津市第一中心医院科技基金(CM201809)。

摘　　要：目的观察联合使用维生素C、维生素B1及氢化可的松对脓毒症血小板减少症(TCP)患者血小板活化的影响.方法采用前瞻性研究方法,选择2019年3月至2020年3月入住天津市第一中心医院重症监护病房(ICU)的脓毒症TCP患者135例作为研究对象.采用不平衡指数最小原则根据年龄、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和血小板计数(PLT)将患者分为联合用药组(50例)、维生素C组(45例)和对照组(40例).3组患者均根据相关指南规范进行抗感染及对症支持治疗.联合用药组患者在常规治疗基础上加用维生素C注射液1.5 g、每6 h 1次,维生素B1注射液200 mg、每12 h 1次,氢化可的松注射液50 mg、每6 h 1次;维生素C组在常规治疗基础上仅加用维生素C注射液1.5 g、每6 h 1次;对照组仅给予抗感染及对症支持治疗,3组疗程均为4 d.检测3组患者入住ICU时和治疗1、2、3、4 d后PLT水平以及入住ICU当日和治疗4 d后血浆可溶性CD40配体(sCD40L)、可溶性P选择素(sP-选择素)水平,并观察不良反应发生情况.结果随治疗时间延长,3组PLT水平逐渐升高,治疗1 d开始维生素C组和联合用药组与本组治疗前比较出现统计学差异(×10^(9)/L:维生素C组为70.84±9.42比62.13±8.86,联合用药组为74.30±7.83比63.14±9.30,均P<0.05);治疗4 d后达峰值,且联合用药组PLT水平明显高于维生素C组和对照组(×10^(9)/L:100.62±10.92比78.98±10.59、74.45±11.32,均P<0.05).3组治疗后sCD40L、sP-选择素均较治疗前降低,且联合用药组sCD40L、sP-选择素均明显低于维生素C组和对照组〔sCD40L(ng/L):3.48±1.23比4.37±1.43、7.15±1.99,sP-选择素(μg/L):166.76±27.95比238.52±36.67、346.09±38.68,均P<0.05〕.3组均未出现相关不良反应.结论维生素C、维生素B1及氢化可的松联合治疗可保护脓毒症TCP患者内皮功能,减少血小板活化,改善血小板减少状态.Objective To observe the effect of vitamin C,thiamine and hydrocortisone in combination on platelet activation in septic patients with thrombocytopenia(TCP).Methods Prospective study was used;the 135 septic patients with TCP in intensive care unit(ICU)of Tianjin First Central Hospital from March 2019 to March 2020 were selected as research objects.According to the principle of minimum imbalance index and based on age,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and platelet count(PLT),the patients were divided into 3 groups:combination group(50 cases),vitamin C group(45 cases)and control group(40 cases).The three groups received regular anti-infection therapy and symptomatic support therapy according to the related guideline.On the basis of conventional and anti-infection treatment,vitamin C injection 1.5 g/6 h,thiamine injection 200 mg/12 h and hydrocortisone 50 mg/6 h were applied in the combination treatment group;the vitamin C injection 1.5 g/6 h was used in vitamin C group and only anti infection and symptomatic support treatment were given to the control group,the therapeutic course being 4 days in the 3 groups.The levels of serum PLT were measured at ICU admission and 1,2,3,4 days during treatment,and the levels of plasma soluble CD40 ligand(sCD40L)and soluble P-selectin(sP-selectin)were measured at ICU admission and after 4 days of treatment.The occurrence of adverse reactions was observed.Results With the prolongation of treatment,the PLT levels of three groups were gradually increased after treatment,after 1 day of treatment,the PLT levels in vitamin C group and combination treatment group had significant differences from those before treatment(X 109/L:70.84±9.42 vs.62.13±8.86 in vitamin C group,74.30±7.83 vs.63.14±9.30 in combination treatment group,both P<0.05],and the PLT levels reached the peak values on 4 days after treatment,and the level was significantly higher in combination treatment group than those in vitamin C group and control group(×10^(9)/L:100.62±10.92 vs.78.9

关 键 词：维生素C 维生素B1 氢化可的松 脓毒症血小板减少症 血小板活化 

分 类 号：R54[医药卫生—心血管疾病]