氢溴酸山莨菪碱对脓毒症相关凝血障碍患者凝血功能及预后的影响研究

Effect of anisodamine hydrobromide on coagulation function and prognosis of patients with sepsis-related coagulation disorders

目的探讨氢溴酸山莨菪碱对脓毒症相关凝血障碍患者凝血功能及预后的影响及其可能的作用机制。方法前瞻性选取2022年4月至2023年10月川北医学院附属医院急诊医学科收治的72例脓毒症相关凝血障碍患者为研究对象,采用随机数字表法分为对照组和治疗组,每组36例。两组患者均予以脓毒症常规治疗,治疗组在常规治疗基础上加用氢溴酸山莨菪碱。收集所有患者入组时的性别、年龄、感染部位、脓毒症相关凝血障碍评分,统计两组患者ICU住院天数、总住院天数及28 d死亡率,记录两组患者治疗前及治疗第3、5、7天急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分及凝血功能指标[包括PT、APTT、Fib、PLT和D-二聚体(D-D)],并在相同时间采集两组患者的血液样本,采用ELISA法检测血浆多配体蛋白聚糖-1(SDC-1)水平。比较两组上述指标。结果治疗组患者ICU住院天数和总住院天数均少于对照组,差异均有统计学意义(均P<0.05);两组患者28 d死亡率比较差异无统计学意义(P>0.05)。治疗组患者治疗第3、5、7天APACHEⅡ评分、血浆SDC-1水平均低于对照组,PLT均高于对照组,治疗第5、7天D-D均低于对照组,差异均有统计学意义(均P<0.05);而两组患者治疗第3、5、7天PT、APTT和Fib比较差异均无统计学意义(均P>0.05)。结论氢溴酸山莨菪碱可以改善脓毒症相关凝血障碍患者的凝血功能及预后,其机制可能与减轻内皮损伤有关。

Objective To explore the effect of anisodamine hydrobromide on the coagulation function and prognosis of patients with sepsis-related coagulation disorders and its possible mechanism.Methods A total of 72 patients with sepsis-related coagulation disorders admitted to the Department of Emergency Medicine of Affiliated Hospital of North Sichuan Medical College from April 2022 to October 2023 were prospectively selected as the research subjects,and they were divided into the control group and the treatment group by random number table method,each with 36 cases.Both groups were given conventional treatment for sepsis,and the treatment group was additionally treated with anisodamine hydrobromide.The gender,age,infection site and Sepsis-related Coagulopathy Score of all patients at enrollment were collected.The ICU stay days,total hospital stay days and 28-day mortality rate of the two groups were statistically analyzed.The Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)Score and coagulation function indicators[including PT,APTT,Fib,PLT and D-dimer(D-D)]of the two groups before treatment and on the 3rd,5th and 7th days of treatment were recorded.Blood samples of the two groups were collected at the same time,and the expression level of plasma syndecan-1(SDC-1)was detected by ELISA.The above indicators of the two groups were compared.Results The ICU stay days and total hospital stay days of the treatment group were both shorter than those of the control group,and the differences were statistically significant(both P<0.05);there was no statistically significant difference in the 28-day mortality rate between the two groups(P>0.05).The APACHEⅡScore and plasma SDC-1 level of the treatment group on the 3rd,5th and 7th days of treatment were lower than those of the control group,while the PLT was higher,D-D on the 5th and 7th days of treatment were lower than those of the control group,and the differences were statistically significant(both P<0.05);while there were no statistically significant differences in PT,APTT and Fib between the two groups on the 3rd,5th and 7th days of treatment(all P>0.05).Conclusion Anisodamine hydrobromide can improve the coagulation function and prognosis of patients with sepsis-related coagulation disorders,and its mechanism may be related to reducing endothelial injury.