益气活血膏方对气虚血瘀型脓毒症患者的临床疗效及对凝血指标的影响
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摘要
目的:探讨益气活血膏方对气虚血瘀型脓毒症患者的临床疗效及治疗前后患者凝血指标的变化。方法:选取2014年5月至2016年3月郑州市中医院收治的气虚血瘀型脓毒症患者79例,随机分为观察组(n=40)与对照组(n=39),对照组给予常规治疗,观察组在对照组的基础上联合益气活血膏方治疗,2组均连续治疗4周。统计2组临床疗效及临床症状改善情况;检测治疗前后2组血清凝血及抗凝指标水平;评价并比较治疗前后2组健康状况。结果:观察组临床总有效率为87.50%,明显高于对照组的66.67%(P<0.05)。与治疗前比较,治疗后对照组仅气短、乏力、舌象等症状积分明显降低(P<0.05),而观察组气短、乏力、神疲、自汗及舌象等症状积分均明显降低,且显著低于对照组(P<0.05)。与治疗前比较,治疗后2组部分凝血酶原时间(APTT)、凝血酶原时间(PT)均明显缩短(P<0.05),且2组间差异无统计学意义(P>0.05);2组D-二聚体(D-D)水平明显降低,且观察组显著低于对照组(P<0.05);观察组血小板(PLT)明显升高,且显著高于对照组(P<0.05);与治疗前比较,治疗后2组血清抗凝血酶Ⅲ(AT-Ⅲ)及活化蛋白C(APC)水平均明显升高,APACHE-Ⅱ评分、SOFA评分均明显降低,2组差异有统计学意义(P<0.05)。结论:益气活血膏方可显著改善气虚血瘀型脓毒症患者的临床症状,有效调节其凝血因子及抗凝因子水平,促进凝血及抗凝平衡,降低血液黏度,可防止机体出血及血栓形成,疗效显著优于常规西药单用。
Objective: To explore the clinical efficacy of Yiqi Huoxue Plaster in the treatment of sepsis patients with qi deficiency and blood stasis pattern and its effects on coagulation indicator. Methods: A total of 79 sepsis patients with qi deficiency and blood stasis pattern who were admitted and treated in Zhengzhou TCM Hospital from May 2014 to March 2016 were selected. All patients were randomly divided into control group( n = 39) and observation group( n = 40). The control group was treated with conventional western medicine treatment,while the observation group wase treated combined with Yiqi Huoxue Plaster on the basis of conventional treatment. Two groups were treated for 4 weeks continuously. The clinical efficacy and the improvement of clinical symptoms were recorded,and the serum coagulation and anti-coagulation indicators before and after treatment were detected. The physical condition of 2 groups before and after treatment were evaluated and compared. Results: The total effective rate of the patients in the observation group( 87. 50%) was significantly higher than that of the control group( 66. 67%)( P < 0. 05). Compared with the state before treatment,the symptoms integral of shortness of breath,lack of strength,tongue picture in control group decreased significantly after treatment( P < 0. 01),while the symptoms integral of shortness of breath,lack of strength,mental fatigue,spontaneous sweating and tongue picture in observation group decreased significantly,which was significantly lower than that in control group after treatment( P < 0. 01). Compared with the state before treatment,the APTT and PT of 2 groups shortened significantly after treatment( P < 0. 01),and there was no significant difference( P > 0. 05). The D-D levels of 2 groups decreased significantly,and that of observation group was lower than that of control group( P < 0. 01). The PLT of observation group increased significantly and higher than that of control group( P < 0. 05). Compared with the state before treatment,the levels of AT-Ⅲ and APC of 2 groups increased significantly,while the scores of APACHE and SOFA decreased significantly when compared with before treatment,with significant difference( P < 0. 01). Conclusion: Yiqi Huoxue Plaster can significantly improve the clinical symptoms of qi deficiency and blood stasis pattern of sepsis patients,regulate effectively the coagulation and anti-coagulation indicators,promote the blood coagulation and anticoagulation equilibrium,reduce the blood viscosity,and prevent hemorrhage and thrombosis. The clinical efficacy is superior to conventional western medicine alone.
Objective: To explore the clinical efficacy of Yiqi Huoxue Plaster in the treatment of sepsis patients with qi deficiency and blood stasis pattern and its effects on coagulation indicator. Methods: A total of 79 sepsis patients with qi deficiency and blood stasis pattern who were admitted and treated in Zhengzhou TCM Hospital from May 2014 to March 2016 were selected. All patients were randomly divided into control group( n = 39) and observation group( n = 40). The control group was treated with conventional western medicine treatment,while the observation group wase treated combined with Yiqi Huoxue Plaster on the basis of conventional treatment. Two groups were treated for 4 weeks continuously. The clinical efficacy and the improvement of clinical symptoms were recorded,and the serum coagulation and anti-coagulation indicators before and after treatment were detected. The physical condition of 2 groups before and after treatment were evaluated and compared. Results: The total effective rate of the patients in the observation group( 87. 50%) was significantly higher than that of the control group( 66. 67%)( P < 0. 05). Compared with the state before treatment,the symptoms integral of shortness of breath,lack of strength,tongue picture in control group decreased significantly after treatment( P < 0. 01),while the symptoms integral of shortness of breath,lack of strength,mental fatigue,spontaneous sweating and tongue picture in observation group decreased significantly,which was significantly lower than that in control group after treatment( P < 0. 01). Compared with the state before treatment,the APTT and PT of 2 groups shortened significantly after treatment( P < 0. 01),and there was no significant difference( P > 0. 05). The D-D levels of 2 groups decreased significantly,and that of observation group was lower than that of control group( P < 0. 01). The PLT of observation group increased significantly and higher than that of control group( P < 0. 05). Compared with the state before treatment,the levels of AT-Ⅲ and APC of 2 groups increased significantly,while the scores of APACHE and SOFA decreased significantly when compared with before treatment,with significant difference( P < 0. 01). Conclusion: Yiqi Huoxue Plaster can significantly improve the clinical symptoms of qi deficiency and blood stasis pattern of sepsis patients,regulate effectively the coagulation and anti-coagulation indicators,promote the blood coagulation and anticoagulation equilibrium,reduce the blood viscosity,and prevent hemorrhage and thrombosis. The clinical efficacy is superior to conventional western medicine alone.
引文
[1]曾文美,毛璞,黄勇波,等.脓毒症预后影响因素分析及预后价值评估[J].中国中西医结合急救杂志,2015,22(2):118-123.
[2]Kohji Okamoto,Toshihisa Tamura,Yusuke Sawatsubashi.Sepsis and disseminated intravascular coagulation[J].J Intensive Care,2016,2(1):43-47.
[3]张平平,王庆树,李志军,等.血必净注射液对脓毒症患者凝血功能的影响[J].中国中西医结合急救杂志,2014,21(3):198-200.
[4]钟声健,张春宝,胡军涛,等.血栓弹力图评价脓毒症患者的凝血功能障碍[J].中华危重病急救医学,2016,28(2):153-158.
[5]蔡桦杨,黄威,刘云涛.益气活血法配合西医疗法干预脓毒症气虚血瘀证的临床疗效[J].中国老年学杂志,2014,34(10):2635-2636.
[6]薛彩红.近10年膏方的研究进展[J].湖南中医杂志,2014,30(11):196-198.
[7]中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[8]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:55-58.
[9]中国人民解放军总后勤部卫生部.临床疾病诊断依据治愈好转标准[M].北京:人民军医出版社,1987:1084-1086.
[10]奚小土,曾瑞峰,丁邦晗,等.脓毒症中西医结合的临床困惑与思考[J].中国中医急症,2016,25(7):1323-1325.
[11]中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[12]巩美鱼,刘保社,段淑琴,等.脓毒症凝血功能障碍患者中医证型与预后相关性研究[J].中国中医急症,2016,25(10):1934-1936.
[13]洪峰.益气活血解毒法对脓毒症凝血指标影响的临床研究[D].合肥:安徽中医药大学,2015.
[14]郭楠,刘清泉,江其敏,等.基于气血相关理论脓毒症凝血功能障碍临床研究[J].中国中医药现代远程教育,2010,8(18):145-147.
[15]Vandijck DM,Blot SI,De Waele JJ,et al.Thrombocytopenia and outcome in critically ill patients with bloodstream infection[J].Heart Lung,2010,38(10):31-36.
[16]洪峰,俞兴群.益气活血法对气虚血瘀型脓毒症患者凝血功能的影响[J].中医药临床杂志,2016,5(5):687-690.
[17]陈伟,胡志华,陈勉.脓毒症患者血浆中抗AT-Ⅲ水平测定的临床意义[J].海南医学院学报,2015,21(8):1060-1061.
[2]Kohji Okamoto,Toshihisa Tamura,Yusuke Sawatsubashi.Sepsis and disseminated intravascular coagulation[J].J Intensive Care,2016,2(1):43-47.
[3]张平平,王庆树,李志军,等.血必净注射液对脓毒症患者凝血功能的影响[J].中国中西医结合急救杂志,2014,21(3):198-200.
[4]钟声健,张春宝,胡军涛,等.血栓弹力图评价脓毒症患者的凝血功能障碍[J].中华危重病急救医学,2016,28(2):153-158.
[5]蔡桦杨,黄威,刘云涛.益气活血法配合西医疗法干预脓毒症气虚血瘀证的临床疗效[J].中国老年学杂志,2014,34(10):2635-2636.
[6]薛彩红.近10年膏方的研究进展[J].湖南中医杂志,2014,30(11):196-198.
[7]中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[8]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:55-58.
[9]中国人民解放军总后勤部卫生部.临床疾病诊断依据治愈好转标准[M].北京:人民军医出版社,1987:1084-1086.
[10]奚小土,曾瑞峰,丁邦晗,等.脓毒症中西医结合的临床困惑与思考[J].中国中医急症,2016,25(7):1323-1325.
[11]中国中西医结合学会急救医学专业委员会,《中国中西医结合急救杂志》编辑委员会.脓毒症中西医结合诊治专家共识[J].中华危重病急救医学,2013,25(4):194-197.
[12]巩美鱼,刘保社,段淑琴,等.脓毒症凝血功能障碍患者中医证型与预后相关性研究[J].中国中医急症,2016,25(10):1934-1936.
[13]洪峰.益气活血解毒法对脓毒症凝血指标影响的临床研究[D].合肥:安徽中医药大学,2015.
[14]郭楠,刘清泉,江其敏,等.基于气血相关理论脓毒症凝血功能障碍临床研究[J].中国中医药现代远程教育,2010,8(18):145-147.
[15]Vandijck DM,Blot SI,De Waele JJ,et al.Thrombocytopenia and outcome in critically ill patients with bloodstream infection[J].Heart Lung,2010,38(10):31-36.
[16]洪峰,俞兴群.益气活血法对气虚血瘀型脓毒症患者凝血功能的影响[J].中医药临床杂志,2016,5(5):687-690.
[17]陈伟,胡志华,陈勉.脓毒症患者血浆中抗AT-Ⅲ水平测定的临床意义[J].海南医学院学报,2015,21(8):1060-1061.