抗血小板治疗对脓毒症炎症反应和血小板功能及治疗效果的影响  

Effects of antiplatelet therapy on inflammatory response,platelet function and therapeutic effect of sepsis

作　　者：吴淑璐 牛凯旋 徐阳 刘成[1] 邓晰明[1] WU Shu-lu;NIU Kai-xuan;XU Yang;LIU Cheng;DENG Xi-ming(Department of Intensive Care,the First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui 233004,China)

机构地区：[1]蚌埠医学院第一附属医院重症医学科,安徽蚌埠233004

出　　处：《中华全科医学》2022年第8期1311-1314,共4页Chinese Journal of General Practice

基　　金：安徽省高校自然科学基金项目(KJ2019A0351)。

摘　　要：目的探讨抗血小板药物阿司匹林对脓毒症患者的炎症控制效果及其安全性。方法选取2020年10月—2021年6月蚌埠医学院第一附属医院重症医学科收治的61例脓毒症患者,按照随机数字表法分为对照组(31例)及实验组(30例)。对照组予以常规脓毒症治疗,实验组予以常规治疗+阿司匹林100 mg,经胃管注入,1次/d,连用7 d。对比2组患者治疗前后PCT、CRP、IL-6水平变化,凝血功能(凝血酶原时间、凝血酶时间、活化部分凝血活酶时间)变化,血小板计数与功能(血栓弹力图中的MA值),并观察阿司匹林常见不良反应(消化道出血)的发生率及患者治疗有效率。结果经过治疗,2组患者的PCT、CRP、IL-6水平均降低,且实验组降低水平明显大于对照组,差异有统计学意义(P值分别为0.012、0.006、0.043)。实验组的凝血功能变化(凝血酶原时间、凝血酶时间、活化部分凝血活酶时间)和血小板计数变化与对照组相比差异无统计学意义(均P>0.05);实验组的血小板功能指标MA变化与对照组相比差异有统计学意义(P=0.023)。实验组的阿司匹林副反应发生率与对照组相比差异无统计学意义(P=0.694);治疗后实验组患者的急性生理与慢性健康评分Ⅱ及序贯器官衰竭评分比对照组降低明显,差异有统计学意义(P值分别为0.048、0.028);实验组的治疗效果与对照组相比差异无统计学意义(P=0.344)。结论抗血小板药物阿司匹林能控制脓毒症患者的炎症反应和血小板功能,且对凝血功能与血小板计数没有明显抑制,并且不增加患者出血的发生率,但没有改善患者的最终治疗效果。Objective To investigate the anti-inflammatory effect and safety of antiplatelet drug aspirin in patients with sepsis.Methods A total of 61 sepsis patients admitted to the Department of Intensive Care Medicine of the First Affiliated Hospital of Bengbu Medical College from October 2020 to June 2021 were selected,including 31 patients in the control group and 30 patients in the experimental group.The control group received conventional sepsis treatment,and the experimental group received conventional treatment+aspirin 100 mg,one time a day,by gastric tube injection,once a day,for 7 days.Changes in the levels of procalcitonin,C-reactive protein and interleukin-6,coagulation function(prothrombin time,thrombin time and activated partial thrombin time),and platelet count and function(MA value in thromboelastic diagram)were compared between the two groups before and after treatment.The incidence of common adverse reactions(gastrointestinal bleeding)and treatment efficiency of aspirin were observed.Results After treatment,the levels of PCT,CRP and IL-6 in the two groups decreased,and the decreased levels in the experimental group were significantly higher than those in the control group(P=0.012,0.006 and 0.043,respectively).There were no significant differences in coagulation function(prothrombin time,thrombin time and activated partial thromboplastin time)and platelet count PLT between the two groups(all P>0.05).The change in platelet function index MA in the experimental group was statistically different from that in the control group(P=0.023).There was no statistical difference in the incidence of aspirin side effects between the two groups(P=0.694).After treatment,acute physiology and chronic health evaluationⅡand sequential organ failure assessment scores in the experimental group were significantly lower than those in the control group,with statistical differences(P=0.048,0.028).There was no statistical difference in the therapeutic effect between the two groups(P=0.344).Conclusion The antiplatelet drug aspirin

关 键 词：脓毒症 抗血小板 广义估计方程 降钙素原 白介素-6 C反应蛋白 

分 类 号：R631[医药卫生—外科学]