血必净联合乌司他丁对脓毒症患者内环境稳态的影响
|
摘要
目的:探讨血必净联合乌司他丁对脓毒症患者内环境稳态的影响。方法:选择在本院接受治疗的烧伤后脓毒症患者78例纳入研究,回顾性分析治疗方案并分为接受乌司他丁治疗的A组40例、接受血必净联合乌司他丁治疗的B组38例,持续治疗7 d后评估疗效。结果:治疗前,两组炎症因子、氧化应激指标、心肌损伤标志物、凝血功能指标水平比较,差异无统计学意义(P>0.05)。治疗后,B组血清中超敏-C反应蛋白(hs-CRP)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子α(TNF-α)的含量低于A组;血清中总抗氧化能力(T-AOC)、谷胱甘肽过氧化物酶(GSH-Px)的含量高于A组,脂质过氧化氢(LHP)、晚期蛋白氧化产物(AOPP)的含量低于A组;血清中乳酸脱氢酶(LDH)、肌钙蛋白Ⅰ(cTnⅠ)、B型脑钠肽(BNP)的含量低于A组;外周血凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血活酶时间(APTT)的水平高于A组,纤维蛋白原(FIB)的水平低于A组(P<0.05)。结论:烧伤后脓毒症患者接受血必净联合乌司他丁治疗,可有效减轻机体炎症应激反应并积极保护心肌功能、减轻高凝状态。
Objective: To investigate the effect of Xuebijing combined with ulinastatin on the homeostasis of sepsis patients. Methods: 78 patients with post-burn sepsis who received treatment in our hospital between January 2016 and January 2019 were included in the study. The treatment regimen was retrospectively analyzed and used to divide the patients into the group A(n=40) receiving ulinastatin treatment and the group B(n=38) receiving Xuebijing combined with ulinastatin treatment. The efficacy was evaluated after 7 d of continuous treatment. Results: Before the treatment, there were no significant differences in levels of inflammatory factors, oxidative stress indicators, myocardial injury markers or coagulation function indicators between the two groups(P>0.05). After the treatment, serum high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) contents in group B were lower than those in group A; serum total antioxidant capacity(T-AOC) and glutathione peroxidase(GSH-Px) contents were higher than those in group A, while lipid hydroperoxide(LHP) and advanced protein oxidation product(AOPP) contents were lower than those in group A; serum lactate dehydrogenase(LDH), troponin I(cTn I) and B-type brain natriuretic peptide(BNP) contents were lower than those in group A; peripheral blood prothrombin time(PT), thrombin time(TT) and partial thromboplastin time(APTT) levels were higher than those in group A, while fibrinogen(FIB) level was lower than that in group A(P<0.05). Conclusion: Xuebijing combined with ulinastatin can effectively reduce the inflammatory stress response, actively protect the myocardial function and reduce the hypercoagulable state in patients with post-burn sepsis.
Objective: To investigate the effect of Xuebijing combined with ulinastatin on the homeostasis of sepsis patients. Methods: 78 patients with post-burn sepsis who received treatment in our hospital between January 2016 and January 2019 were included in the study. The treatment regimen was retrospectively analyzed and used to divide the patients into the group A(n=40) receiving ulinastatin treatment and the group B(n=38) receiving Xuebijing combined with ulinastatin treatment. The efficacy was evaluated after 7 d of continuous treatment. Results: Before the treatment, there were no significant differences in levels of inflammatory factors, oxidative stress indicators, myocardial injury markers or coagulation function indicators between the two groups(P>0.05). After the treatment, serum high-sensitivity C-reactive protein(hs-CRP), interleukin-6(IL-6), interleukin-8(IL-8) and tumor necrosis factor-α(TNF-α) contents in group B were lower than those in group A; serum total antioxidant capacity(T-AOC) and glutathione peroxidase(GSH-Px) contents were higher than those in group A, while lipid hydroperoxide(LHP) and advanced protein oxidation product(AOPP) contents were lower than those in group A; serum lactate dehydrogenase(LDH), troponin I(cTn I) and B-type brain natriuretic peptide(BNP) contents were lower than those in group A; peripheral blood prothrombin time(PT), thrombin time(TT) and partial thromboplastin time(APTT) levels were higher than those in group A, while fibrinogen(FIB) level was lower than that in group A(P<0.05). Conclusion: Xuebijing combined with ulinastatin can effectively reduce the inflammatory stress response, actively protect the myocardial function and reduce the hypercoagulable state in patients with post-burn sepsis.
引文
1 Li XX,Ding XY,Shi P,et al.Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children's hospital,2013 to 2017[J].Medicine (Baltimore),2019,98(12):e14686.
2 Abdel-Hady H,Yahia S,Megahed A,et al.Mediators in preterm infants with late-onset sepsis:A randomized controlled trial[J].J Pediatr Gastroenterol Nutr,2019,68(4):578-584.
3 Kempker JA,Kramer MR,Waller LA,et al.State-level hospital compliance with and performance in the centers for medicaid & medicare services' early management severe sepsis and septic shock bundle[J].Crit Care,2019,23(1):92.
4 吕彦.奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效及安全性分析[J].中国现代药物应用,2019,13(1):123-124.
5 马天威,马明远,邓梦华,等.乌司他丁对心肺复苏后患者肾功能的保护作用[J].海南医学,2017,28(12):1928-1931.
6 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
7 Hwang JS,Kim KH,Park J,et al.Glucosamine improves survival in a mouse model of sepsis and attenuates sepsis-induced lung injury and inflammation[J].J Biol Chem,2019,294(2):608-622.
8 Marchesi S,Ortiz Nieto F,Ahlgren KM,et al.Abdominal organ perfusion and inflammation in experimental sepsis:a magnetic resonance imaging study [J].Am J Physiol Gastrointest Liver Physiol,2019,316(1):G187-G196.
9 Li DZ,Zhou YX,Yu J,et al.Evaluation of a novel prognostic score based on thrombosis and inflammation in patients with sepsis:a retrospective cohort study[J].Clin Chem Lab Med,2018,56(7):1182-1192.
10 乔增海,尚志博.乌司他丁对重症脓毒症患者血浆PCT、CRP水平的影响及对心肝肾的保护作用[J].河北医药,2018,40(8):1172-1174,1179.
11 Zarbato GF,de Souza Goldim MP,Giustina AD,et al.Dimethyl fumarate limits neuroinflammation and oxidative stress and improves cognitive impairment after polymicrobial sepsis[J].Neurotox Res,2018,34(3):418-430.
12 Gerin F,Sener U,Erman H,et al.The effects of quercetin on acute lung injury and biomarkers of inflammation and oxidative stress in the rat model of sepsis[J].Inflammation,2016,39(2):700-705.
13 张玮,褚永果,李伟,等.参附注射液对脓毒症肠黏膜屏障功能障碍患者血清肠型脂肪酸结合蛋白、可溶性CD14亚型及氧化应激水平的影响[J].中医杂志,2018,59(6):494-497.
14 郭海雷,卢才教,刘政军,等.脓毒症大鼠早期血管内皮和心肌损害及其相关性研究[J].中国现代医生,2018,56(10):37-41.
15 Shang XL,Li J,Yu RG,et al.Sepsis-related myocardial injury is associated with Mst1 upregulation,mitochondrial dysfunction and the Drp1/F-actin signaling pathway[J].J Mol Histol,2019,50(2):91-103.
16 Wang XH,Yu Y.MiR-146b protect against sepsis induced mice myocardial injury through inhibition of Notch1[J].J Mol Histol,2018,49(4):411-417.
17 Liang DS,Huang AR,Jin YM,et al.Protective effects of exogenous NaHS against sepsis-induced myocardial mitochondrial injury by enhancing the PGC-1α/NRF2 pathway and mitochondrial biosynthesis in mice[J].Am J Transl Res,2018,10(5):1422-1430.
18 Shah M,Patnaik S,Maludum O,et al.Mortality in sepsis:Comparison of outcomes between patients with demand ischemia,acute myocardial infarction,and neither demand ischemia nor acute myocardial infarction[J].Clin Cardiol,2018,41(7):936-944.
19 Yang SF,Qi HZ,Kan KJ,et al.Neutrophil extracellular traps promote hypercoagulability in patients with sepsis[J].Shock,2017,47(2):132-139.
20 熊泽忠,梁大胜,韩志邦.乌司他丁对ICU老年脓毒症患者炎症状态及凝血功能的影响[J].广西医学,2017,39(8):1257-1258,1261.
2 Abdel-Hady H,Yahia S,Megahed A,et al.Mediators in preterm infants with late-onset sepsis:A randomized controlled trial[J].J Pediatr Gastroenterol Nutr,2019,68(4):578-584.
3 Kempker JA,Kramer MR,Waller LA,et al.State-level hospital compliance with and performance in the centers for medicaid & medicare services' early management severe sepsis and septic shock bundle[J].Crit Care,2019,23(1):92.
4 吕彦.奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效及安全性分析[J].中国现代药物应用,2019,13(1):123-124.
5 马天威,马明远,邓梦华,等.乌司他丁对心肺复苏后患者肾功能的保护作用[J].海南医学,2017,28(12):1928-1931.
6 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
7 Hwang JS,Kim KH,Park J,et al.Glucosamine improves survival in a mouse model of sepsis and attenuates sepsis-induced lung injury and inflammation[J].J Biol Chem,2019,294(2):608-622.
8 Marchesi S,Ortiz Nieto F,Ahlgren KM,et al.Abdominal organ perfusion and inflammation in experimental sepsis:a magnetic resonance imaging study [J].Am J Physiol Gastrointest Liver Physiol,2019,316(1):G187-G196.
9 Li DZ,Zhou YX,Yu J,et al.Evaluation of a novel prognostic score based on thrombosis and inflammation in patients with sepsis:a retrospective cohort study[J].Clin Chem Lab Med,2018,56(7):1182-1192.
10 乔增海,尚志博.乌司他丁对重症脓毒症患者血浆PCT、CRP水平的影响及对心肝肾的保护作用[J].河北医药,2018,40(8):1172-1174,1179.
11 Zarbato GF,de Souza Goldim MP,Giustina AD,et al.Dimethyl fumarate limits neuroinflammation and oxidative stress and improves cognitive impairment after polymicrobial sepsis[J].Neurotox Res,2018,34(3):418-430.
12 Gerin F,Sener U,Erman H,et al.The effects of quercetin on acute lung injury and biomarkers of inflammation and oxidative stress in the rat model of sepsis[J].Inflammation,2016,39(2):700-705.
13 张玮,褚永果,李伟,等.参附注射液对脓毒症肠黏膜屏障功能障碍患者血清肠型脂肪酸结合蛋白、可溶性CD14亚型及氧化应激水平的影响[J].中医杂志,2018,59(6):494-497.
14 郭海雷,卢才教,刘政军,等.脓毒症大鼠早期血管内皮和心肌损害及其相关性研究[J].中国现代医生,2018,56(10):37-41.
15 Shang XL,Li J,Yu RG,et al.Sepsis-related myocardial injury is associated with Mst1 upregulation,mitochondrial dysfunction and the Drp1/F-actin signaling pathway[J].J Mol Histol,2019,50(2):91-103.
16 Wang XH,Yu Y.MiR-146b protect against sepsis induced mice myocardial injury through inhibition of Notch1[J].J Mol Histol,2018,49(4):411-417.
17 Liang DS,Huang AR,Jin YM,et al.Protective effects of exogenous NaHS against sepsis-induced myocardial mitochondrial injury by enhancing the PGC-1α/NRF2 pathway and mitochondrial biosynthesis in mice[J].Am J Transl Res,2018,10(5):1422-1430.
18 Shah M,Patnaik S,Maludum O,et al.Mortality in sepsis:Comparison of outcomes between patients with demand ischemia,acute myocardial infarction,and neither demand ischemia nor acute myocardial infarction[J].Clin Cardiol,2018,41(7):936-944.
19 Yang SF,Qi HZ,Kan KJ,et al.Neutrophil extracellular traps promote hypercoagulability in patients with sepsis[J].Shock,2017,47(2):132-139.
20 熊泽忠,梁大胜,韩志邦.乌司他丁对ICU老年脓毒症患者炎症状态及凝血功能的影响[J].广西医学,2017,39(8):1257-1258,1261.