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目的观察重组人活化蛋白C(rhAPC)对儿童脓毒症休克的疗效及安全性。方法选择我院儿科及重症监护病房2011年1月-2014年3月间收治的60例脓毒症休克患儿,随机分为对照组(n=30)和rhAPC组(n=30)。对照组患儿给予对症治疗,rhAPC组患儿在此基础上静脉注射rhAPC 24μg/(kg·h),连续给药4 d。2组患儿于治疗前及治疗后检测血浆纤维蛋白原和D-二聚体水平及炎症因子IL-6、IL-8、TNF-α、动脉血氧饱和度(SaO2)和中心静脉压(CVP)。结果 rhAPC组患儿治疗后血浆纤维蛋白原和D-二聚体水平及炎症因子IL-6、IL-8和TNF-α均显著低于对照组,而SaO2和CVP高于对照组,其差异均有统计学意义(P<0.05)。rhAPC组1例患儿发生出血性膀胱炎。结论 rhAPC能有效抑制脓毒症休克患儿的炎症反应,降低血液高凝状态。
Objective To observe the efficacy and safety of recombinant human activated protein C (rhAPC) in septic shock in children. Methods Sixty children with sepsis admitted to our pediatric and intensive care unit from January 2011 to March 2014 were randomly divided into control group (n = 30) and rhAPC group (n = 30). Control group of children given symptomatic treatment, rhAPC group on the basis of intravenous rhAPC 24μg / (kg · h), continuous administration of 4 d. The levels of plasma fibrinogen and D-dimer and the levels of inflammatory cytokines IL-6, IL-8, TNF-α, arterial oxygen saturation (SaO2) and central venous pressure CVP). Results The levels of plasma fibrinogen and D-dimer and the levels of IL-6, IL-8 and TNF-α in the rhAPC group were significantly lower than those in the control group, while SaO2 and CVP were higher in the rhAPC group than in the control group All were statistically significant (P <0.05). One case of rhAPC had hemorrhagic cystitis. Conclusion rhAPC can effectively inhibit the inflammatory response in septic shock and reduce the hypercoagulability in blood.