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目的探讨血必净注射液对凝血功能障碍脓毒症患者的临床应用价值和可能的作用机制。方法将2009年1月-2010年12月合肥市第二人民医院重症医学科收治的伴有凝血功能障碍的脓毒症患者78例,按照随机数字表法分为对照组38例,治疗组40例,后者在常规治疗基础上加用血必净注射液50 ml静脉滴注,2次/d,连用7 d,分别检测两组患者治疗前及治疗7 d后凝血酶原时间(PT),活化部分凝血酶原时间(APTT),纤维蛋白原(Fib),血小板计数(PLT)等凝血指标水平,并检测C反应蛋白浓度(CRP),同时行急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)和器官功能衰竭(Marshall)评分,并记录患者ICU住院时间及28 d病死率。结果治疗7 d后两组患者凝血功能均有所好转,但治疗组较对照组改善明显(P<0.05);两组患者治疗后APACHEⅡ评分及Marshall评分均明显下降(P<0.05),但治疗组较对照组下降更明显(P<0.05);治疗组较对照组C反应蛋白浓度下降明显(P<0.05);治疗组ICU平均住院日较对照组有所缩短,但差异无统计学意义(P>0.05);对照组患者死亡8例,病死率为21.05%(8/38),治疗组死亡7例,病死率17.50%(7/40)。结论血必净注射液能够改善脓毒症患者的凝血功能,明显提高疗效,改善脓毒症患者的预后,是治疗脓毒症的临床有效药物。
Objective To investigate the clinical value and the possible mechanism of Xuebijing injection in patients with coagulopathy and sepsis. Methods Seventy-eight patients with coagulopathy who were admitted to Department of Critical Care Medicine, Second People’s Hospital of Hefei from January 2009 to December 2010 were divided into control group (38 cases) and treatment group (40 cases) according to random number table For example, the latter on the basis of conventional therapy plus Xuebijing injection 50 ml intravenous infusion, 2 times / d, once every 7 days, respectively, before and after treatment 7 d treatment to detect prothrombin time (PT) APTT, fibrinogen and platelet count (PLT), and C-reactive protein (CRP) were measured. Acute Physiology and Chronic Health Evaluation System Ⅱ APACHEⅡand Marshall score, and recorded the patient’s ICU hospitalization time and 28d fatality rate. Results After 7 days of treatment, the coagulation function of both groups improved, but the treatment group improved significantly compared with the control group (P <0.05). The APACHEⅡscore and Marshall score of the two groups were significantly decreased (P <0.05) after treatment, but the treatment (P <0.05). The concentration of C-reactive protein in the treatment group decreased significantly compared with the control group (P <0.05). The average length of hospital stay in the treatment group was shorter than that in the control group (P <0.05), but the difference was not statistically significant P> 0.05). In the control group, 8 patients died, with a mortality rate of 21.05% (8/38). Seven patients died in the treatment group with a mortality rate of 17.50% (7/40). Conclusion Xuebijing injection can improve the coagulation function of patients with sepsis, significantly improve the efficacy and improve the prognosis of patients with sepsis, is a clinically effective drug for the treatment of sepsis.