血必净联合山莨菪碱治疗对多发伤伴失血性休克患者炎性因子、免疫功能及凝血功能的影响

Effect of combined treatment with Xuebijing and anisodamine on inflammatory factors,immune function and coagulation function in patients with multiple trauma and hemorrhagic shock

目的探究血必净联合山莨菪碱治疗对多发伤伴失血性休克患者炎性因子、免疫功能以及凝血功能的影响。方法选取2019年5月~2020年5月我院收治的多发伤伴失血性休克患者87例,将其分为对照组(42例)和观察组(45例)。对照组给予早期液体复苏治疗,观察组在对照组的基础上另予以血必净联合山莨菪碱治疗,两组均连续治疗48 h。对比分析两组治疗前、治疗48 h后炎性因子水平[白细胞介素-6/10(IL-6/10)和肿瘤坏死因子(TNF-α)]、免疫功能情况[CD4^(+)、CD3^(+)、自然杀伤细胞(NK细胞)、CD4^(+)/CD8^(+)],凝血功能情况[血小板计数(PLT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)以及纤维蛋白原时间(FIB)]。并记录患者循环系统及组织灌注氧代谢情况[平均动脉压(MAP)、乳酸、pH值以及中心静脉血氧饱和度Scv(O_(2))]。结果治疗48 h后,观察组IL-6、IL-10以及TNF-α水平均低于对照组(P<0.05)。两组治疗48 h后的CD4^(+)、CD3^(+)、CD4^(+)/CD8^(+)均较治疗前提高,NK细胞水平下降(P<0.05);治疗48 h后观察组CD4^(+)、CD3^(+)、CD4^(+)/CD8^(+)均高于对照组(P<0.05),NK细胞水平低于对照组(P<0.05)。治疗48 h后,观察组PLT、PT、APTT以及TT均高于对照组,FIB低于对照组(P<0.05)。两组治疗48 h后的MAP比较差异无统计学意义(P>0.05),但观察组的pH值和Scv(O_(2))均高于对照组,乳酸水平低于对照组(P<0.05)。结论血必净联合山莨菪碱治疗能够提高多发伤伴失血性休克患者早期液体复苏的效果,改善患者凝血功能,降低炎症因子水平,并提高机体免疫功能。

Objective To explore the effect of Xuebijing combined with anisodamine on inflammatory factors,immune function and coagulation function in patients with multiple injuries and hemorrhagic shock.Methods 87 patients with multiple injuries and hemorrhagic shock were enrolled in this study between May 2019 and May 2020.Using random number table method,the patients enrolled were divided into control group(42 cases)and observation group(45 cases).The control group was given early fluid resuscitation therapy,and the observation group was treated with Xuebijing combined with anisodamine on this basis.Both groups were given 48h of continuous treatment.The levels of inflammatory factors[interleukin-6/10(IL-6/10),and tumor necrosis factor(TNF-α)],immune function[CD4^(+),CD3^(+),natural killer cells(NK cells),CD4^(+)/CD8^(+)],and coagulation function[platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT)and fibrinogen(FIB)]in the two groups before treatment and after 48h of treatment were comparatively analyzed.The condition of circulatory system and tissue perfusion oxygen metabolism[mean arterial pressure(MAP),lactate,pH value and central venous oxygen saturation(ScvO_(2))]were recorded.Results After 48h of treatment,the levels of IL-6,IL-10 and TNF-αin the two groups decreased(P<0.05),and the decreases of the observation group were greater than those of the control group(P<0.05).CD4^(+),CD3^(+)and CD4^(+)/CD8^(+) were increased,and the level of NK cells decreased(P<0.05).There was no statistical difference in MAP between the two groups(P>0.05).PLT,PT,APTT and TT in the observation group were higher than those in the control group,and FIB was lower than that in the control group(P<0.05).The pH value and ScvO_(2) of the observation group were higher than those of the control group,and the lactate level was lower than that in the control group(P<0.05).Conclusion Xuebijing combined with anisodamine can improve the effect of early fluid resuscitation in patients with multiple injuries and hemorrhagic shock,improve their coagulation function,reduce the levels of inflammatory factors,and improve immune function.