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目的观察血必净注射液治疗对多发性创伤早期并发脓毒症、多器官功能障碍综合征(MODS)患者预后的影响。方法选择急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分>15分的多发性创伤患者60例,随机分为治疗组和对照组,每组30例。两组均按多发性创伤常规治疗;治疗组在常规治疗基础上于入院1 d起用血必净注射液80 ml静脉滴注,12 h 1次,连用7d。统计两组脓毒症和MODS的发生率以及28 d病死率;检测入院即刻、3、5和7 d APACHEⅡ评分及血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6、IL-10水平。结果入院3d起,治疗组APACHEⅡ评分和TNF-α、IL-1β、IL-6、IL-10水平均低于对照组,至5d时下降更明显,两组比较差异有统计学意义(P均<0.05)。治疗组脓毒症发生率为43.3%(13/30),MODS发生率为23.3%(7/30),病死率为13.3%(4/30);对照组脓毒症发生率为63.3%(19/30),MODS发生率为53.3%(16/30),病死率为40.0%(12/30),两组比较差异均有统计学意义(P均<0.05)。结论多发性创伤早期应用血必净注射液能减轻病情严重程度,显著降低脓毒症、MODS的发生率,从而改善多发性创伤患者的预后。
Objective To observe the effect of Xuebijing Injection on the prognosis of patients with multiple trauma complicated with early sepsis and multiple organ dysfunction syndrome (MODS). Methods Sixty patients with multiple traumatic injuries with acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score> 15 were randomly divided into treatment group and control group, with 30 cases in each group. Both groups were treated by routine trauma. On the basis of routine treatment, the treatment group was given 80 ml of Xuebijing injection once daily for 12 hours once a day for 7 days. The incidence of sepsis and MODS in the two groups and the 28-day mortality were calculated. APACHEⅡscore and serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL- 1β), IL-6, IL-10 levels. Results On the 3rd day after admission, the APACHEⅡscore and the levels of TNF-α, IL-1β, IL-6 and IL-10 in the treatment group were lower than those in the control group, and decreased more obviously on the 5th day <0.05). The incidence of sepsis in treatment group was 43.3% (13/30), the incidence of MODS was 23.3% (7/30) and the case fatality rate was 13.3% (4/30). The incidence of sepsis in control group was 63.3% 19/30). The incidence of MODS was 53.3% (16/30) and the mortality rate was 40.0% (12/30). There was significant difference between the two groups (all P <0.05). Conclusions Early application of Xuebijing injection in multiple trauma can reduce the severity of the disease, significantly reduce the incidence of sepsis and MODS, and thus improve the prognosis of patients with multiple trauma.