灯盏花素对脓毒症急性肺损伤患者炎性因子、凝血功能的影响及疗效研究

doi:10.11958/20221250

摘要/Abstract

摘要：

目的探讨灯盏花素对脓毒症急性肺损伤（ALI）患者炎性因子、凝血功能的影响及临床疗效。方法 84例脓毒症致ALI患者按随机数字表法分为对照组、灯盏花素低剂量组（灯低组）和灯盏花素高剂量组（灯高组），每组28例。对照组采用西医常规治疗，灯低组在对照组治疗基础上加用灯盏花素注射液（20 mg，1次/d），灯高组在对照组治疗基础上加用灯盏花素注射液（40 mg，1次/d），3组均治疗2周。评价3组患者临床疗效，比较3组治疗前及治疗2周后中医症候积分、氧合指数（PaO₂/FiO₂）、白细胞介素（IL）-6及肿瘤坏死因子-α（TNF-α）水平，测定凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）及血小板计数，记录3组治疗期间药物相关不良事件。结果灯低组和灯高组临床疗效和总有效率均优于对照组（P<0.05）；3组治疗后中医症候积分及IL-6、TNF-α水平均较治疗前下降，且对照组、灯低组及灯高组依次降低（P<0.05）；3组治疗后PT、APTT均较治疗前延长，且对照组、灯低组及灯高组依次延长（P<0.05）；3组治疗后PaO₂/FiO₂、血小板计数均较治疗前增加，且对照组、灯低组及灯高组依次增加（P<0.05）。治疗中3组均未出现严重药物不良事件。结论灯盏花素可明显改善脓毒症时凝血功能障碍，减少血小板不正常的消耗，抑制炎症反应，对脓毒症所致的ALI患者具有较为确切的临床疗效。

关键词: 脓毒症, 炎症, 灯盏花素, 急性肺损伤, 凝血功能

Abstract:

Objective To explore effects and clinical efficacy of breviscapine on inflammatory factors and coagulation function in patients with septic acute lung injury (ALI). Methods A total 84 patients with ALI caused by sepsis were assigned to the control group, the low-dose breviscapine group (low-dose group) and the high-dose breviscapine group (high-dose group) according to random digital table, with 28 cases in each group. The control group was treated with conventional Western medicine. The low-dose group was additionally given breviscapine injection (20 mg, one time/d) on the basis of the control group, and the high-dose group was additionally given breviscapine injection (40 mg, one time/d) on the basis of the control group. The three groups were treated for 2 weeks. The clinical efficacy were evaluated in the three groups. Traditional Chinese medicine (TCM) syndrome scores, oxygenation index (PaO₂/FiO₂), interleukin (IL) -6 and tumor necrosis factor-α (TNF-α) levels, prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet count were compared before and after two weeks of treatment between the three groups. Drug-related adverse events during treatment were recorded in each group. Results The clinical efficacy and total effective rate were better in the low-dose group and the high-dose group compared with those of the control group (P<0.05). After treatment, the TCM syndrome score and levels of IL-6 and TNF-α were decreased than those before treatment in the three groups (P<0.05), and the control group, the low-dose group and the high-dose group were decreased successively. After treatment, PT and APTT were prolonged compared with those before treatment in the three groups, and the control group, the low-dose group and the high-dose group were prolonged successively (P<0.05). After treatment, PaO₂/FiO₂ and platelet count were increased compared with those before treatment in the three groups, and the control group, the low-dose group and the high-dose group were increased successively (P<0.05). There were no severe adverse drug events during the treatment in the three groups. Conclusion Breviscapine can significantly improve the coagulation dysfunction in sepsis, reduce the abnormal consumption of platelets, inhibit inflammatory response, and has a relatively definite clinical effect on patients with sepsis-induced acute lung injury.

Key words: sepsis, inflammation, breviscapine, acute lung injury, coagulation function

中图分类号:

R631

图/表 6

参考文献 21

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组别	性别（男/女）	年龄（岁）	APACHEⅡ（分）	Murry肺损伤评分（分）	感染部位^＃（例）
对照组	16/12	70.11±7.09	24.43±2.67	2.89±0.34	11/7/4/3/3
灯低组	14/14	72.04±6.32	23.86±2.79	2.83±0.37	10/8/5/3/2
灯高组	15/13	69.54±6.71	25.11±2.42	2.93±0.41	12/6/4/4/2
F或χ²	0.287	1.066	1.583	0.661	1.482

组别	性别（男/女）	年龄（岁）	APACHEⅡ（分）	Murry肺损伤评分（分）	感染部位^＃（例）
对照组	16/12	70.11±7.09	24.43±2.67	2.89±0.34	11/7/4/3/3
灯低组	14/14	72.04±6.32	23.86±2.79	2.83±0.37	10/8/5/3/2
灯高组	15/13	69.54±6.71	25.11±2.42	2.93±0.41	12/6/4/4/2
F或χ²	0.287	1.066	1.583	0.661	1.482

组别	显效	有效	无效	总有效
对照组	4（14.29）	13（46.43）	11（32.14）	17（60.71）
灯低组	7（21.43）	16（60.71）	5（17.86）	23（82.14）
灯高组	8（25.00）	17（64.29）	3（10.71）	25（89.29）
χ²	6.085^*			6.582^*

组别	显效	有效	无效	总有效
对照组	4（14.29）	13（46.43）	11（32.14）	17（60.71）
灯低组	7（21.43）	16（60.71）	5（17.86）	23（82.14）
灯高组	8（25.00）	17（64.29）	3（10.71）	25（89.29）
χ²	6.085^*			6.582^*

组别	治疗前	治疗后	t
对照组	14.32±2.25	11.79±2.67	7.392^**
灯低组	14.75±2.19	9.86±2.73^a	23.534^**
灯高组	15.07±2.14	7.43±2.38^ab	38.052^**
F	0.825	16.843^**