血必净注射液对脓毒症患者合并急性胃肠损伤的影响:一项回顾性队列研究  

Effect of Xuebijing injection on acute gastrointestinal injury in patients with sepsis:a retrospective cohort study

作　　者：左志刚 裴柳 张艳敏 刘天植 刘秀娟 胡振杰[4] Zuo Zhigang;Pei Liu;Zhang Yanmin;Liu Tianzhi;Liu Xiujuan;Hu Zhenjie(Department of Critical Care Medicine,the First Hospital of Qinhuangdao Affiliated to Hebei Medical University&the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China;Department of Inspection,the First Hospital of Qinhuangdao Affiliated to Hebei Medical University&the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China;Department of Gastroenterology,the First Hospital of Qinhuangdao Affiliated to Hebei Medical University&the First Hospital of Qinhuangdao,Qinhuangdao 066000,Hebei,China;Department of Critical Care Medicine,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,Hebei,China)

机构地区：[1]河北医科大学附属秦皇岛市第一医院/秦皇岛市第一医院重症医学科,河北秦皇岛066000 [2]河北医科大学附属秦皇岛市第一医院/秦皇岛市第一医院检验科,河北秦皇岛066000 [3]河北医科大学附属秦皇岛市第一医院/秦皇岛市第一医院消化内科,河北秦皇岛066000 [4]河北医科大学第四医院重症医学科,石家庄050011

出　　处：《中华危重病急救医学》2024年第9期943-949,共7页Chinese Critical Care Medicine

基　　金：河北省中医药管理局科研计划项目(2024150)。

摘　　要：目的观察血必净注射液对脓毒症合并急性胃肠损伤(AGI)的影响,分析脓毒症合并AGI的危险因素。方法采用回顾性队列研究方法,收集2021年5月1日至2023年10月30日秦皇岛市第一医院重症医学科收治的非胃肠道来源脓毒症患者的基线资料、脓毒症感染源、生命体征、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)、实验室检查指标、合并症、治疗过程的干预措施和28 d预后情况。根据是否使用血必净注射液将患者分为血必净组和非血必净组;再根据是否合并AGI将患者分为合并AGI组和未合并AGI组。主要观察指标为血必净组与非血必净组患者AGI发生率差异以及入院7 d降钙素原(PCT)、C-反应蛋白(CRP)、白细胞计数(WBC)下降幅度和28 d病死率差异。通过单因素分析探讨脓毒症患者合并AGI的危险因素,筛选有统计学意义的指标纳入二元Logistic回归分析确定独立危险因素。结果共纳入129例非胃肠道来源的脓毒症患者,其中血必净组57例,非血必净组72例;合并AGI组80例,未合并AGI组49例。血必净组和非血必净组患者在性别、年龄、体质量指数(BMI)、基础疾病、感染源、生命体征、APACHEⅡ评分、SOFA评分、临床干预措施等方面比较差异均无统计学意义,实验室检查方面除天冬氨酸转氨酶(AST)和血尿素氮(BUN)外其余指标比较差异均无统计学意义。血必净组AGI发生率明显低于非血必净组〔50.87%(29/57)比70.83%(51/72),P<0.05〕,28 d病死率略低于非血必净组〔24.56%(14/57)比30.56%(22/72),P>0.05〕;血必净组入院7 d CRP、PCT、WBC下降幅度均大于非血必净组,其中CRP下降幅度(mg/L:47.12±67.34比7.76±111.03)和PCT下降幅度〔μg/L:14.08(-1.22,50.40)比2.94(-1.27,14.80)〕差异均有统计学意义(均P<0.05)。单因素分析显示,使用抑酸剂、使用镇痛镇静剂、未使用血必净注射液、肺部感染、泌尿系感染是脓毒症患Objective To observe the effect of Xuebijing injection on sepsis combined with acute gastrointestinal injury(AGI),and analyze the risk factors of sepsis combined with AGI.Methods A retrospective cohort study was conducted.Patients with non-gastrointestinal origin admitted to the department of intensive care medicine of the First Hospital of Qinhuangdao from May 1,2021 to October 30,2023 were enrolled.The baseline data,source of sepsis infection,vital signs,acute physiology and chronic health evaluationⅡ(APACHEⅡ),sequential organ failure assessment(SOFA),laboratory tests,comorbidities,interventions during treatment,and the 28-day prognosis were collected.The patients were divided into Xuebijing group and non-Xuebijing group according to whether Xuebijing injection was used or not.According to whether AGI was merged or not,patients were divided into merged AGI group and non-merged AGI group.The main observational indexes were the difference in the incidence of AGI between the Xuebijing group and non-Xuebijing group and the difference in the magnitude of the decline in procalcitonin(PCT),C-reactive protein(CRP),and white blood cell count(WBC)at 7 days after admission,and the difference in the 28-day morbidity and mortality.Risk factors for AGI in septic patients were explored by univariate analysis,and statistically significant indicators were screened and included in binary Logistic regression analysis to determine independent risk factors.Results A total of 129 patients with sepsis of non-gastrointestinal origin were enrolled,including 57 patients in the Xuebijing group and 72 patients in the non-Xuebijing group.Among 129 patients,80 patients in the merged AGI group and 49 patients in the non-merged AGI group.There were no statistically significant differences between Xuebijing group and non-Xuebijing group in gender,age,body mass index(BMI),underlying disease,source of infection,vital sign,APACHEⅡscore,SOFA score,and clinical intervention,and there were no statistically significant differences in laboratory

关 键 词：脓毒症 急性胃肠损伤 血必净注射液 

分 类 号：R459.7[医药卫生—急诊医学] R57[医药卫生—治疗学]