血必净对严重脓毒症血小板减少症患者的疗效观察

摘要

目的 观察血必净对脓毒症血小板减少症(TCP)患者炎症反应、内皮功能紊乱及血小板活化的影响.方法 收集2015-01～2016-01入住天津市第一中心医院ICU脓毒症TCP患者61例进行前瞻性研究,另选15例同期健康体检者为对照组(C组).根据年龄、APACHEⅡ评分及血小板计数(PLT)三个因素应用“不平衡指数最小原则”将患者随机分为非血必净治疗组(A组,30例)和血必净治疗组(B组,31例).两组均进行常规治疗,B组在西医常规治疗基础上加用血必净注射液,7d为一疗程.采用酶联免疫吸附法(ELISA)测定血清vWF、TNF-α和血浆sCD40L.追踪两组患者28 d病死率.结果 ①与治疗前比较,A、B组治疗后PLT明显上升(P＜0.05和P＜0.01),两组间1、3d比较差异无统计学意义(P＞0.05),5、7dB组PLT高于A组(P＜0.05).②与治疗前比较,B组治疗后vWF、TNF-α及sCD40L明显下降(P＜0.01或P＜0.05),A组vWF、sCD40L明显下降(P＜0.05),TNF-α治疗前后无明显变化(P＞0.05).A、B组治疗前两组差异无统计学意义,B组治疗后vWF、TNF-α及sCD40L较A组有所降低(P＜0.05).③A、B组28 d病死率比较差异无统计学意义(P＞0.05).结论 血必净注射液能够减轻脓毒症炎症反应,保护内皮功能,减少PLT活化,改善脓毒症TCP患者PLT低状态.%Objective To observe the effect of Xuebijing on inflammatory reaction,endothelium dysfunction and platelet activation in septic patients with thrombocytopenina(TCP).Methods A total of 61 septic pactients with TCP in Intensive Care Unit of Tianjin First Central Hospital from January 2015 to January 2016 were included in this prospective study.The people who came at the same period for physical examination were taken as the normal control group (n =15).Randomly divided the 61 patients into non-Xuebijing group A (n =30) and Xuebijing group B (n =31),according to the principle of minimum distribution imbalance index with age,scores of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),platelet count three factors.Both group A and group B received conventional therapy,group B add Xuebijing injection for 7 days.The level of serum von Willebrand factor (vWF),TNF-α and plasma sCD40L were measured by enzyme linked immune sorbent assay (ELISA).The 28-day mortality of the two groups was traced.Results ①Compared with pre-treatment,the platelet count of group A,B improved significantly post-treatment (P ＜0.05 & P ＜0.01),on the first and third day of admission,there was no significant difference between group A and group B (P ＞ 0.05),on the fifth and seventh day of admission,the platelet count of group B was higher than group A (P ＜0.05).②Compared with pre-treatment,the level of vWF,TNF-α and sCD40L of group B decreased significantly post-treatment (P ＜ 0.01 & P ＜ 0.05),and the level of vWF,sCD40L of group A increased significantly post-treatment (P ＜ 0.05).However,TNF-α had no significant change before and after treatment (P ＞ 0.05).The level of vWF,TNF-α and sCD40L of group B was lower than group A after treatment (P ＜ 0.05).③The 28-day mortality of group A and B had no significant difference (P ＞ 0.05).Conclusion Xuebijing injection reduces the sepsis inflammatory reaction,protects endothelial function,downregulates platelet activation,and improves the situation of low platelet count of septic patient with TCP.