清源生化汤对脓毒症患者凝血功能障碍的影响

The Influence of Qingyuan Shenghua Decoction on Coagulation Dysfunction in Patients with Septicemia

目的:观察清源生化汤对脓毒症患者凝血功能障碍的影响。方法:将80例脓毒症患者按照随机数字表法分为对照组和治疗组,每组各40例。对照组给予常规西医治疗,治疗组在对照组治疗的基础上口服或鼻饲自拟清源生化汤治疗。检测两组患者治疗前后凝血酶原时间(prothrombin time, PT)、活化部分凝血活酶时间(activated partial thromboplastin time, APTT)、国际标准化比值(international normalized ratio, INR)、纤维蛋白原(fibrinogen, Fib)、D-二聚体、血小板计数(platelet, PLT)、白细胞计数(white blood cell, WBC)、C-反应蛋白(C-reactive protein, CPR)和降钙素原(procalcitonin, PCT)水平,比较两组患者治疗前后急性生理与慢性健康状况评分系统II(acute physiology and chronic health evaluation II,APACHE II)评分、序贯性器官衰竭(sequential organ failure, SOFA)评分;记录两组患者ICU住院时间、多器官功能障碍综合征(multiple organ dysfunction syndrome, MODS)发生率和28 d内病死率。结果:两组患者治疗后PT、APTT、INR、Fib及D-二聚体水平低于本组治疗前,PLT高于本组治疗前,治疗后治疗组PT、APTT、INR、Fib及D-二聚体水平低于对照组,PLT高于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后WBC、CRP、PCT、APACHE II评分、SOFA评分低于本组治疗前,且治疗后治疗组低于对照组,差异均有统计学意义(P<0.05)。治疗组ICU住院时间明显短于对照组,差异具有统计学意义(P<0.05),对照组MODS发生率和28 d病死率高于治疗组,但差异无统计学意义(P>0.05)。结论:自拟清源生化汤治疗脓毒症,可改善患者凝血功能,减轻炎症反应。

Objective:To observe the clinical curative effect of Qingyuan Shenghua Decoction(清源生化汤,QYSHD)on coagulation dysfunction in patients with septicemia.Methods:A total of 80 patients with coagulation dysfunction due to septicemia were randomly divided into the control group and the treatment group,with 40 cases in each group.The control group was treated with conventional Western medicine,while the treatment group was treated with self-made QYSHD by oral or nasal feeding on the basis of the control group.Prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR),fibrinogen(Fib),D-dimer,platelet count(PLT),white blood cell(WBC),C-reactive protein(CPR)and procalcitonin(PCT)levels before and after treatment were measured.The scores of acute physiology and chronic health evaluation II(APACHE II)and sequential organ failure(SOFA)were compared between the two groups before and after treatment.The length of stay in ICU,the incidence of multiple organ dysfunction syndrome(MODS)and the mortality within 28 days were recorded.Results:After treatment,PT,APTT,INR,Fib and D-dimer in the two groups were lower than those of the same group before treatment,while their PLT was higher than that of the same group before treatment.PT,APTT,INR,Fib and D-dimer in the treatment group were lower than those in the control group,but PLT was higher than that in the control group,and all the differences were statistically significant(P<0.05).The WBC,CRP,PCT,APACHE II and SOFA scores of the two groups after treatment were lower than those of the same group before treatment,and the above indexes of the treatment group were lower than those of the control group after treatment,and all the differences were statistically significant(P<0.05).The length of stay in ICU in the treatment group was significantly shorter than that in the control group,and the difference was statistically significant(P<0.05).The incidence of MODS and the mortality within 28 days in the control group was higher than that in the treatment group,but the difference was not statistically significant(P>0.05).Conclusion:QYSHD can improve coagulation function and reduce inflammatory reaction in patients with septicemia.