血必净、喜炎平、钠美芬对重症胸腹损伤急性肝细胞功能损伤的保护作用与机制

PROTECTIVE EFFECT OF XUEBIJING,XIYANPING COMBINED WITH NALMEFENE IN HEPATIC CELLS INSUFFICIENCY DURING SEVERE THORACOABDOMINAL INJURIES AND ITS MECHANISMS

目的探讨血必净(XBJ)、喜炎平、钠美芬联合干预对重症胸腹损伤急性肝细胞功能损伤的保护作用与机制。方法以2009年1月—2013年6月在该院就诊,创伤指数(TI)≥17分,除外合并颅脑损伤及急诊死亡的重症胸腹创伤患者为入选标准,观察组112例,对照组57例;观察组和对照组患者在就诊及入院时分别检查谷丙转氨酶(ALT)、谷草转氨酶(AST);肿瘤坏死因子-α(TNF-α)、内毒素(LPS)、白细胞介素-6(IL-6)、磷脂酶A2(PLA2)。结果观察组患者就诊时ALT(328.43±21.35)U/L,AST(298.49±19.62)U/L;入院时ALT(58.12±11.67)U/L,AST(54.72±10.31)U/L。对照组患者就诊时ALT(323.27±25.46)U/L,AST(283.58±20.29)U/L,入院时ALT(350.88±27.72)U/L,AST(302.91±24.31)U/L。治疗后ALT、AST降低,与治疗前及对照组相比P<0.01。结论 XBJ、喜炎平、钠美芬联合干预对重症胸腹损伤急性肝细胞功能损伤有明显的保护作用,对减少并发症、改善预后具有重要意义。

Objective To explore the protective effect and relative mechanisms of Xuebijing,Xiyanping combined with nalmefene in hepatic cells insufficiency during severe thoracoabdominal injuries.Methods Severe thoracoabdominal injury patients with trauma index （TI）≥ 17 points except the ones associated craniocerebral injuries and died in emergency department were randomly divided into two groups：the treat-ment group （n=112 ）and the control group （n=57）;The patients were all collected at 253th Hosptital of PLA between January 2009 and June 2013,and they received tests at the time of arriving at and the time of （AST）,tumor necrosis factor-α（TNF-α）,lipopolysaccharide （LPS）,interleukin-6 （IL-6）and phos-pholipase A2 （PLA2）.Results At the time of arriving at the emergency department and leaving the emer-gency department to the inpatient department,the records of the treatment group were as follow：ALT （328.43±21.35）U/L and （58.12±11.67）U/L,AST （298.49 ±19.62）U/L and （54.72±10.31）U/L,repectively.At the above time,the records of the control group were as follow：ALT （323.27±25.46） U/L and （350.88 ±27.72）U/L,AST （283.58 ±20.29）U/L and （302.91 ±24.31 ）U/L.After treat-ment,ALT and AST levels of the treatment group were significantly lower than before treatment and than the control group （all P 〈0.01）.Conclusions Combined Xuebijing and Xiyanping with nalmefene can sig-nificantly improve the hepatic cells insufficiency during severe thoracoabdominal injuries which have impor-tant significance in reducing incidence rate of complication and improve prognosis.