血必净注射液对急诊重度脓毒症患者凝血功能影响  

Effect of Xuebijing injection on coagulation function in emergency patients with severe sepsis

作　　者：陈敏[1] 周伟君[1] 车在前[1] 马丽[1] 赵冰[1] 邵建伟[1] 毛恩强[1] 陈尔真[1] CHEN Min;ZHOU Weijun;CHE Zaiqian;MA Li;ZHAO Bing;SHAO Jianwei;MAO Enqiang;CHEN Erzhen(Department of Emergency,Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院急诊科,上海200025

出　　处：《职业卫生与应急救援》2023年第4期421-425,435,共6页Occupational Health and Emergency Rescue

基　　金：上海市卫生计生系统重要薄弱学科建设项目(2016ZB0206);上海市科学技术委员会科研计划项目(18411950900)。

摘　　要：目的探讨血必净注射液治疗急诊重度脓毒症患者的疗效,及其对机体凝血功能的影响。方法采用随机数字表法将78例脓毒症患者分为对照组(n=39)和血必净组(n=39),两组患者均按照《2016年脓毒症和感染性休克处理国际指南》给予常规抗脓毒症集束化治疗,血必净组在常规治疗基础上给予血必净注射液治疗,对照组给予等量氯化钠注射液治疗。检测并比较两组患者治疗前和治疗7 d后血小板计数(platelet count,PLT)、凝血功能、血栓弹力图数值结果,以及两组急性生理学和慢性健康状况评价系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、急诊重症监护室住院时间和28 d病死率。结果治疗7 d后,血必净组患者PLT计数显著较前上升,纤维蛋白降解产物(fibrin/fibrinogen degradation products,FDP)较前明显下降(P均<0.05);对照组患者PLT计数依旧下降(P<0.01)。治疗7 d后,血必净组患者FDP、D-二聚体低于对照组(P<0.01),凝固时间明显缩短,α角、最大血块强度(maximum clot strength,MA)值、CI-综合凝血指数明显增大,且均优于对照组(P<0.05)。对照组以上指标在治疗前后差异均无统计学意义(P>0.05)。治疗7 d后,两组患者APACHⅡ评分均较治疗前下降(P<0.05),但血必净组表现更优(P<0.05)。血必净组28 d死亡率为17.95%,低于对照组的23.08%。结论常规对症治疗联合血必净注射液能有效改善脓毒症患者的凝血功能,血必净注射液在脓毒症患者治疗中有积极作用。Objective To explore the efficacy of Xuebijing injection in the treatment of emergency patients with severe sepsis and its impact on coagulation function.Methods Seventy-eight patients with severe sepsis were randomly divided into the control group(n = 39) and the Xuebijing group(n = 39) by the random number table method.All patients in both groups were treated with routine anti-sepsis bundle therapy according to the 2016 International Guidelines for the Treatment of Sepsis and Septic Shock.In addition to these routine treatments,the Xuebijing group was treated with a Xuebijing injection,while the control group was given an equal amount of sodium chloride.The platelet count(PLT),coagulation function,thromboelastography(TEG) values,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,the stay time at the emergency intensive care unit,and the fatality rate within 28 days were compared between these two groups before and after 7 days of treatment.Results After 7 days of treatment,the PLT count in the Xuebijing group increased significantly,and the fibrin/fibrinogen degradation products(FDP) decreased significantly(P<0.05);the PLT count in the control group continued to decrease(P<0.01).After 7 days of treatment,FDP and D-Dimer(DD) in the Xuebijing group were lower than those in the control group(P<0.01),and clot formation time was significantly shortened;α angle,maximum clot strength(MA),and coagulation index(CI) were significantly increased,and all were better than those in the control group(P<0.05).There was no statistically significant difference in these indicators before and after treatment in the control group(P>0.05).After 7 days of treatment,APACH Ⅱ scores in both groups decreased compared to before treatment(P<0.05),but the performance of the Xuebijing group was better(P<0.05).The 28-day fatality rate in the Xuebijing group was 17.95%,lower than that in the control group at 23.08%.Conclusions Combined with routine symptomatic treatment,Xuebijing injection could effectively improve the coag

关 键 词：急诊 重度脓毒症 血必净 凝血功能 血栓弹力图 

分 类 号：R459.7[医药卫生—急诊医学] R114[医药卫生—治疗学]