摘要
目的探讨血必净对脓毒性休克患者炎症反应及预后的影响。方法采用前瞻性随机对照研究方法,以2019年1月至12月郑州大学第一附属医院重症医学科收治的80例脓毒性休克患者为研究对象。按随机数字表法将患者分为血必净组和对照组,每组40例。两组均严格按照脓毒性休克诊疗指南进行综合治疗,血必净组在此基础上静脉滴注血必净注射液100 mL,每日2次,连用7 d。记录入组患者基线资料;于治疗前及治疗3、7、10 d测定血清白细胞介素-6(IL-6)、降钙素原(PCT)、C-反应蛋白(CRP)、肝素结合蛋白(HBP)等炎性因子水平;记录机械通气时间、重症监护病房(ICU)住院时间、总住院时间及28 d病死率。比较两组间各指标的差异,并应用二分类Logistic回归分析影响患者预后的独立危险因素。结果①两组患者基线资料如性别、年龄、感染部位、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分(SOFA)等差异均无统计学意义。②两组治疗后血清炎性因子水平均呈下降趋势;治疗7 d时,血必净组IL-6、HBP已较对照组明显降低〔IL-6(ng/L):66.20(16.34,163.71)比79.81(23.95,178.64),HBP(ng/L):95.59(45.23,157.37)比132.98(73.90,162.05)〕,治疗10 d时PCT、CRP、IL-6、HBP均较对照组明显降低〔PCT(μg/L):1.14(0.20,3.39)比1.31(0.68,4.21),CRP(mg/L):66.32(19.46,115.81)比89.16(20.52,143.76),IL-6(ng/L):31.90(13.23,138.74)比166.30(42.75,288.10),HBP(ng/L):62.45(29.17,96.51)比112.33(58.70,143.96)〕,差异均有统计学意义(均P<0.05)。③血必净组机械通气时间、ICU住院时间较对照组明显缩短,总住院费用明显减少〔机械通气时间(h):57.0(0,163.5)比168.0(24.0,282.0),ICU住院时间(d):8.80±4.15比17.13±7.05,总住院费用(万元):14.55±7.31比20.01±9.86,均P<0.05〕,但28 d病死率和总住院时间差异无统计学意义〔28 d病死率:37.5%比35.0%,总住院时间(d):13.05±8.44比18.30±9.59,均P>0.05〕。④根据28 d预后将患者分为死亡组和存活组,单因素分析显示,影响患者预后的因素有白细胞计数(WBC)、中性粒细胞比例(NEU%)、CRP、血乳酸(Lac)、APACHEⅡ评分、IL-6、HBP;对上述指标进一步行Logistic回归分析显示,CRP、IL-6、APACHEⅡ评分为影响患者预后的独立危险因素〔优势比(OR)分别为1.007、1.828、1.229,均P<0.05〕。结论联合血必净治疗脓毒性休克患者在一定程度上能减轻机体炎症反应,从而缩短机械通气时间、ICU住院时间,减少住院费用,但并不能降低患者28 d病死率。
Objective To study the effect of Xuebijing on inflammatory response and prognosis in patients with septic shock.Methods A prospective randomized controlled study was conducted.Eighty septic shock patients admitted to department of critical care medicine of the First Affiliated Hospital of Zhengzhou University from January to December in 2019 were enrolled.The enrolled patients were divided into Xuebijing group and control group by randomized number table method,with 40 cases in each group.Both groups were strictly followed the guidelines for the diagnosis and treatment of septic shock to take comprehensive treatment measures against sepsis.On this basis,Xuebijing group received intravenous 100 mL Xuebijing injection twice a day for 7 days.Baseline data of enrolled patients were recorded.The levels of interleukin-6(IL-6),procalcitonin(PCT),C-reactive protein(CRP)and heparin binding protein(HBP)were measured before treatment and 3,7 and 10 days after treatment.Mechanical ventilation time,the length of intensive care unit(ICU)stay,total hospitalization time and 28-day mortality were recorded.The differences of every indicator between the two groups were compared.Independent risk factors affecting patient prognosis were analyzed by binary Logistic regression.Results①There was no significant difference in baseline data such as gender,age,infection site,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure score(SOFA)between the two groups.②The levels of serum inflammatory factors in both groups showed a decreasing trend after treatment.Compared with the control group,IL-6 and HBP in the Xuebijing group significantly decreased on day 7[IL-6(ng/L):66.20(16.34,163.71)vs.79.81(23.95,178.64),HBP(ng/L):95.59(45.23,157.37)vs.132.98(73.90,162.05),both P<0.05];on day 10,PCT,CRP,IL-6 and HBP significantly decreased[PCT(μg/L):1.14(0.20,3.39)vs.1.31(0.68,4.21),CRP(mg/L):66.32(19.46,115.81)vs.89.16(20.52,143.76),IL-6(ng/L):31.90(13.23,138.74)vs.166.30(42.75,288.10),HBP(ng/L):62.45(29.17,96.51)vs.112.33(58.70,143.96),all P<0.05].③Compared with the control group,mechanical ventilation time and the length of ICU stay were significantly shortened and the total hospitalization expenses were significantly reduced in Xuebijing group[mechanical ventilation time(hours):57.0(0,163.5)vs.168.0(24.0,282.0),the length of ICU stay(days):8.80±4.15 vs.17.13±7.05,the total hospitalization expenses(ten thousand yuan):14.55±7.31 vs.20.01±9.86,all P<0.05].There was no significant difference in 28-day mortality and the total hospitalization time[28-day mortality:37.5%vs.35.0%,the total hospitalization time(days):13.05±8.44 vs.18.30±9.59,both P>0.05].④Patients were divided into death and survival groups according to the prognosis,and univariate analysis showed that white blood cell(WBC),neutrophil percentage(NEU%),CRP,lactic acid(Lac),APACHEⅡscore,IL-6,HBP were the factors influencing the prognosis of patients.The above indicators were further analyzed by Logistic regression,which showed that CRP,IL-6,and APACHEⅡscore were independent risk factors for prognosis[odds ratio(OR)was 1.007,1.828,1.229,all P<0.05].Conclusions Combined with Xuebijing to treat septic shock can reduce the body's inflammatory response to a certain extent,thereby reducing the time of mechanical ventilation,shortening the stay of ICU and reducing the total cost of hospitalization.But it cannot reduce the 28-day mortality of patients with septic shock.
作者
孙荣青
梁明
杨宏富
刘启龙
马宁
魏丹
董方杰
Sun Rongqing;Liang Ming;Yang Hongfu;Liu Qilong;Ma Ning;Wei Dan;Dong Fangjie(Department of Critical Care Medicine,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2020年第4期458-462,共5页
Chinese Critical Care Medicine
基金
国家临床重点专科建设项目(2011-873)
河南省省直医疗机构医疗服务能力提升工程建设项目(2017-66)。
关键词
脓毒性休克
血必净
炎症反应
预后
Septic shock
Xuebijing
Inflammatory response
Prognosis
作者简介
通信作者:孙荣青,Email:rongqing.sun@126.com。
