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目的:探讨加味四妙勇安汤对脓毒症患者凝血功能紊乱的影响。方法:纳入热毒炽盛证脓毒症患者60例,随机分为治疗组和对照组,每组30例。两组均给予西医常规方法治疗,治疗组加用加味四妙勇安汤治疗,治疗周期为7 d。评价两组患者的中医证候疗效,治疗前后检测两组患者的白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平,比较两组患者的凝血酶原时间(PT)、血浆凝血酶时间(TT)、部分凝血酶原时间(APTT)及D-二聚体(D-D)、抗凝血酶Ⅲ(ATⅢ)水平。结果:治疗后,治疗组的中医证候疗效总有效率为90.00%,对照组为76.67%,两组比较差异无统计学意义(P>0.05)。治疗后,两组患者的IL-8、TNF-α水平均显著降低(P<0.01,P<0.05),且治疗组患者的TNF-α水平低于对照组(P<0.05);治疗组患者的DD水平明显降低(P<0.01),ATⅢ水平显著升高(P<0.05),且治疗组患者的ATⅢ水平显著高于对照组(P<0.01)。结论:加味四妙勇安汤结合西医常规疗法能够明显减轻脓毒症患者的炎症反应,改善患者的凝血功能紊乱状态。
Objective: To investigate the effect of Modified Simiao Yongan Decoction on coagulation disorders in sepsis patients. Methods: Sixty patients with sepsis were divided into treatment group (n = 30) and control group (n = 30). Both groups were given routine western medicine treatment, the treatment group plus Modified Simiao Yongan treatment, the treatment cycle was 7 d. The curative effect of traditional Chinese medicine (TCM) syndrome was evaluated in both groups. The levels of interleukin-8 (IL-8) and tumor necrosis factor-α (TNF-α) in both groups were measured before and after treatment. Prothrombin time (PT) , Plasma thrombin time (TT), partial prothrombin time (APTT) and D-dimer (DD), antithrombin Ⅲ (AT Ⅲ) levels. Results: After treatment, the total effective rate of TCM syndromes in the treatment group was 90.00% and that in the control group was 76.67%. There was no significant difference between the two groups (P> 0.05). After treatment, the levels of IL-8 and TNF-α in both groups were significantly decreased (P <0.01, P <0.05), and the levels of TNF-α in the treatment group were lower than those in the control group (P <0.05) (P <0.01). The level of ATⅢ was significantly increased (P <0.05), and the level of AT Ⅲ in the treatment group was significantly higher than that in the control group (P <0.01). Conclusion: Modified Simiao Yongan Decoction combined with conventional Western medicine can significantly reduce the inflammatory response in patients with sepsis and improve the patient’s coagulopathy status.