血必净注射液对改善严重多发伤患者预后作用的研究

连向阳　古纪欢　王金宝

【摘要】 目的：观察血必净注射液对严重多发伤患者炎症因子、凝血功能及肝肾功能的影响，探讨其对严重多发伤患者预后的改善作用。方法：将本院2012年1月-2014年1月收治的76例严重多发伤患者按随机数字表法分为治疗组和对照组，每组38例。对照组予以常规综合治疗，治疗组在对照组的基础上早期加用0.9% 氯化钠注射液100 mL+血必净注射液100 mL，静脉滴注，2次/d，连续用药7 d。分别检测两组在治疗前和治疗后7 d的炎症因子水平、凝血功能指标以及反应肝肾功能的检验指标，并观察两组患者并发症发生率、死亡率，同时记录急性生理和慢性健康状况（APACHE Ⅱ）评分。结果：与治疗前相比，治疗第7天观察组并发症发生率、APACHE Ⅱ评分以及炎症因子水平均有所下降，凝血功能、肝肾功能均明显改善，比较差异均有统计学意义（P<0.05），两组间比较差异均有统计学意义（P<0.05），提示治疗组指标下降幅度（改善幅度）大于对照组。结论：早期应用血必净注射液可以从一定程度上改善严重多发伤患者的预后，其机制可能与血必净注射液能够减少炎性介质的释放、改善凝血功能从而对人体重要脏器具有保护作用有關。

【关键词】 血必净注射液； 严重多发伤； 炎症反应； 凝血功能； 预后

【Abstract】 Objective：To observe the influences of Xuebijing Injection on inflammatory factors，blood coagulation function and liver and kidney function of patients with severe multiple trauma，to explore its improvement on patients with severe multiple trauma.Method：76 patients with severe multiple trauma were selected in our hospital from January 2012 to January 2014，they were divided into the treatment group and the control group according to the random number table method，38 cases in each group.The control group was given routine comprehensive treatment，while the treatment group was added with 100 mL of 0.9% NS+100 mL of Xuebijing Injection，intravenous drip，twice daily for consecutive 7 days on the basis of routine comprehensive treatment.Before and after treatment，the inflammatory factors，blood coagulation indicators，liver and kidney function of two groups were detected，the incidence of complications and mortality of two groups were observed， the acute physiology and chronic health conditions （APACHE Ⅱ scores） of two groups were recorded.Result：Compared with before treatment，the incidence of complications，APACHE Ⅱ scores and inflammatory factor levels of two groups after treatment were decreased on the 7th day，the blood coagulation function，liver and kidney function of two groups after treatment were obviously improved，the differences were statistically significant（P<0.05）.And the decline （improvement） of the indexes in the treatment group were better than those of the control group，the differences were statistically significant（P<0.05）.Conclusion：Early application of Xuebijing Injection can improve the prognosis of patients with severe multiple trauma to certain extent，and its mechanism may be related to that Xuebijing Injection can reduce the release of inflammatory mediators and improve the function of blood coagulation so as to protective important organs of human body.

【Key words】 Xuebijing Injection； Severe multiple trauma； Inflammatory response； Blood coagulation function； Prognosis

First-authors address：Shenzhen Shajing Hospital，Affiliated to Guangzhou Medical University，Shenzhen 518104，China

doi：10.3969/j.issn.1674-4985.2017.07.022

多发伤是单一致伤因素造成的2个或2个以上解剖部位（根据AIS-90版所指的9个部位）的损伤，其严重程度则视其ISS值而定，凡ISS>16分者定为严重多发伤[1]。随着我国交通事业和高层建筑业的迅猛发展，各类意外创伤特别是严重多发伤事件日益增多，而严重多发伤发病急骤、病情凶险、变化迅速、伤情复杂、救治难度大，且严重多发伤患者，就诊时往往合并休克、呼吸困难等，致残率与致死率均较高[2]，已成为35岁以下人群首要致死病因[3]。鉴于其对社会的巨大危害性，目前国内外文献对于严重多发伤的诊治研究报道颇多，而关于严重多发伤预后的研究报道相对较少。……