血必净治疗严重肺挫伤效果分析

Efficacy analysis of the treatment of Xuebijing in the severe pulmonary contusion patients

目的探讨血必净对肺挫伤患者炎性细胞因子肿瘤坏死因子仪（TNF—α）、血管性假血友病因子（vWF）、白细胞介素6（IL-6）的调节作用及治疗效果的影响。方法选取2010年1月至2012年1月我院收治的肺挫伤患者51例，随机分为治疗组及对照组。采用酶联免疫吸附试验测定肺挫伤患者TNF-α、vWF、IL-6浓度，观察治疗组及对照组炎性细胞因子的变化及治疗效果。结果治疗组与对照组住院时间分别为（19．83±2．35）、（21．52±2．73）d，治疗组住院时间明显缩短（t=2．38，P〈0．05）；急性呼吸窘迫综合征发生率分别为14．81％（4／27），41．67％（10／24），治疗组发生率明显降低（X2=4．60，P〈0．05）；治疗组与对照组炎症指标分别为TNF-仪第1天（181．35±14．25）、（179．17±16．28）ng／L，第3天（169．21±16．42）、（179．18±17．31）n异／L，第5天（131．78±13．02）、（140．84±14．27）ng／L，第7天（99．45±16．02）、（110．56±17．09）ng／L；vWF第1天（178．73±22．09）、（177．73±23．02）ng／L，第3天（208．46±14．13）、（220．53±23．02）ng／L，第5天（252．32±15．22）、（266．40±25．79）ng／L，第7天（201．49±9．21）、（217．27±22．68）ng／L；IL-6第1天（172．14±12．41）、（169．53±13．55）ng/L，第3天（147．24±16．33）、（158．41±21．04）ng／L，第5天（126．36±11．37）、（137．21±21．23）ng／L，第7天（114．03±10．26）、（122．16±13．59）ng／，L，其差异均具有统计学意义（F组内=206．58、P〈0．01，F组间=19．053、P〈0．01；F组内=218．57、P〈0．01，F组间：17．259、P〈0．01；F组内=198．35、P〈0．01，F组间=17．235、P〈0．01）。且第3、5、7天3项指标浓度治疗组均低于对照组（P均〈0．01）。结论血必净能抑制肺挫伤患者机体炎性细胞因子的产生，减轻炎症反应，降低ARDS发生率，缩短病程，有助于改善严重肺挫伤患者的预后。

Objective To investigate the effects of Xuebijing on the regulations of tumor necrosis factor-α（ TNF-α）, van Wilebrand factor （ vWF）, interleukin-6 （ IL-6 ） and the treatment effectiveness in pulmonary contusion patients. Methods Fifty-one pulmonary contusion patients admitted into the hospital from January 2010 to January 2012 were enrolled in the study and were randomly divided into two groups （ treatment group and control group）. The levels of the TNF-α,vWF ,IL-6 in the pulmonary contusion patients were measured by enzyme linked immunosorbent assay to investigate the change of the inflammatory cytokines and the treatment effectiveness in treatment group and control group. Results The hospitalization time of treatment group and control group was （ 19. 83 ± 2. 35 ） d, （ 21.52 ± 2.73 ） d respectively, the hospitalization time of the treatment group was significantly shorter than the control group ,the difference was statistically significant （t = 2. 38 ,P 〈 0.05） ;The incidence of ARDS was 14. 81% and 41.67% respectively, the incidence of ARDS of the treatment group was significantly lower,the difference was statistically significant （ X2 =4. 6 ,P 〈 0.05 ） ;The inflammatory mediators index of the two groups showed as follws ： the first day of the TNF-α（ 181.35 ± 14. 25 ） ng/L, （ 179. 17 ± 16. 23）ng/L, the third day of the TNF-α （ 169. 21 ±16. 42） ng/L, （ 179. 18 ± 17. 31 ） ng/L, the fifth day of the TNF-α（ 131.78 ±13.02） ng/L, （ 140. 84 ± 14. 27 ） ng/L, the seventh day of the TNF-α（99.45 ± 16.02） ng/L, （ 110. 56 ± 17.09） ng/L;The first day of the vWF（ 178.73 ±22. 09） ng/L, （ 177. 73 ±23.02） ng/L,the third day of the vWF（208.46 ± 14. 13 ） ng/L, （220. 53± 23.02） ng/L, the fifth day of the vWF（252. 32 ± 15.22） ng/L, （266.40 ±25.79） ng/L,the seventh day of the vWF（201.49 ±9. 21 ） ng/L, （217. 27 ±22. 68） ng/L;The first day of the IL-6 （ 172. 14±12.41 ） rig/L, （ 169. 53 ± 13.55 ） ng/L, the third day of the IL-6 （147.24 ± 16.33） ng/L, （158.41 ±21.04） ng/L, the fifth day of the IL-6 （126.36 ± 11.37） ng/L, （ 137.21 ± 21.23） ng/L, the seventh day of the IL-6 （ 114. 03± 10. 26） ng/L, （ 122. 16 ± 13.59） ng/L, the differences within the group and between the two groups were significant （within the group ：F = 206. 58,218. 57, 198.35 respectively, P 〈 0. 01 ;between the groups ：F = 19. 053,17. 259,17. 235 respectively, P 〈 0. 01 ）. And in the third,fifth and seventh day,3 indicators of treatment groups were lower than the control group（ P 〈 0. 01 ）. Conclusion Xuebijing can inhibit inflammatory transmitters, relieve inflammatory reactions, decrease the rate of ARDS incidence,shorten the hospitalization time and help to improve the prognosis of the patients with acute pulmonary contusion.