重组人活化蛋白C治疗儿童脓毒症休克的临床观察

Clinical observation of recombinant human activated protein C in the treatment of pediatric septic shock

目的观察重组人活化蛋白C(rhAPC)对儿童脓毒症休克的疗效及安全性。方法选择我院儿科及重症监护病房2011年1月-2014年3月间收治的60例脓毒症休克患儿,随机分为对照组(n=30)和rhAPC组(n=30)。对照组患儿给予对症治疗,rhAPC组患儿在此基础上静脉注射rhAPC 24μg/(kg·h),连续给药4 d。2组患儿于治疗前及治疗后检测血浆纤维蛋白原和D-二聚体水平及炎症因子IL-6、IL-8、TNF-α、动脉血氧饱和度(SaO2)和中心静脉压(CVP)。结果 rhAPC组患儿治疗后血浆纤维蛋白原和D-二聚体水平及炎症因子IL-6、IL-8和TNF-α均显著低于对照组,而SaO2和CVP高于对照组,其差异均有统计学意义(P<0.05)。rhAPC组1例患儿发生出血性膀胱炎。结论 rhAPC能有效抑制脓毒症休克患儿的炎症反应,降低血液高凝状态。

Objective： To investigate the recombinant human activated protein C （rhAPC）treatment in children with septic shock. Methods： 60 cases of septic shock patients in our hospital pediatric and intensive care unit from 2011 January to 2014 year in March admitted, were randomly divided into control group（n=30） and rhAPC group（n=30）, the control group was given conventional treatment, the rhAPC group in the conventional treatment combined with rhAPC intravenous injection, 24 μg/（kg.h）, continuous administration of 4 day, review two group coagulation, inflammation factor IL-6, IL-8, TNF-α and extracellular signal regulated protein kinase levels. Results： After the treatment, the rhAPC group of plasma fibrinogen and D- dimer level in two and inflammatory cytokines IL-6, IL-8, TNF-α were significantly lower than the control group, while the expression of extracellular signal regulated protein kinase levels were higher than the control group, the differences were statistically significant （P〈0.05）. Conclusion rhAPC can significantly inhibit the inflammatory response in pediatric septic shock, decreased blood hypercoagulability.