血必净治疗严重脓毒症45例临床观察及其对炎症反应的影响

Clinical Observation of Xuebijing Injection in the Treatment of Severe Sepsis and Influence for Inflammatory Response

目的 明确血必净治疗严重脓毒症临床疗效及其对炎症反应的影响.方法 2013年6～11月入住我院急诊科ICU的严重脓毒症患者随机分为治疗疗组45例,对照组46例,两组患者均接受常规治疗,治疗组在常规治疗基础上加用血必净注射液(天津红日药业股份有限公司)100ml加入生理盐水100ml静脉滴注,2次/d.对照组静脉滴注100ml加入生理盐水,2次/d.两组患者均连续接受治疗7d.比较治疗前和治疗7d后患者的降钙素原(PCT)、C反应蛋白(CRP)、白细胞(WBC)、白细胞介素-6(IL-6)及白细胞介素-10(IL-10)、肿瘤坏死因子(TNF-α)水平变化以及急性生理学号慢性健康状况评分系统Ⅱ(APACHEII)评分,以及住ICU时间、总住院时间和28d病死率.结果 两组患者较治疗前各项指标均得到显著改善(P＜0.05),但治疗组改善情况优于对照组.与对照组相比,治疗组PCT、CRP、IL-6及TNF-a水平降低更明显(6.92±0.77vs4.64±0.54,67.06±16.73vs39.79±11.97,8.92±1.85vs6.78±1.61,87.98±9.07vs74.58±4.51,P＜0.05),IL-10水平更高(110.83±35.19vs76.27±31.44,P＜0.05);且APACH EⅡ评分下降趋势也更显著(15.26±2.74vs20.01±4.18,P＜0.05);血必净治疗组患者的住ICU时间、总住院时间显著低于对照组(15.29±2.73vs25.52±11.24,11.78±4.25vs18.77±12.10,P＜0.05),但两组28d病死率相当.结论 血必净注射液急诊治疗严重脓毒症显著改善炎症反应,降低APACHEⅡ评分,有效缓解病情,缩短住院时间,临床疗效确切,安全性良好.

Objective To observe the effect of Xuebijing injection in the treatment of severe sepsis in emergency department,and the effects of Xuebijing injection for inflammatory response. Methods Severe sepsis patients in our department from June 2013 to November 2013 were divided into two groups,treatment group of 45 patients, control group with 46 patients. Two groups patients were treated with conventional therapy, the treatment group was received the conventional therapy plus Xuebijing injection(100 ml,intravenous drip,2 times per day for 7 days).Before and after 7 days' treatment,record changes in the level of procalcitonin(PCT), C reactive protein(CRP), white blood cell(WBC), interleukin 6(IL 6) and interleukin 10(IL 10), tumor necrosis factor(TNFα), acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score, ICU stay, hospital stay and 28 days' mortality were compared in two groups. Results Compared with before treatment, patients of two groups were significantly improved(P<0.05), but improvement was better than the control group. Compared with the control group,the levels of PCT, CRP, IL 6 and TNF were significantly decreased in treatment group(6.92 ±0.77 vs.4.64 ±0.54, 67.06 ±16.73 vs 39.79 ±11.97, 8. 92 ±1. 85 vs 6.78 ±1 61, 87.98 ±9.07 vs 74.58 ±4.51, P <0.05), higher level of IL￣10(110.83±35.19 vs. 76.27±31.44, P<0.05); APACHEⅡ score decreasing trend was much more obvious in the treatment group(15.26±2.74 vs. 20.01±4.18, P<0.05); Compared with control group, the average ICU stay and total LOS were significantly reduced in the treatment group.However, two groups were no significant differences in 28-day mortality rate(P>0.05). Conclusion In emergency department, Xuebijing injection in the treatment of severe sepsis significantly improved the inflammation, reduced APACHE Ⅱscore, alleviated the condition, shortered hospital stays. Clinical efficacy and safety was good.