摘要
目的观察羟乙基淀粉溶液复苏对感染性休克患者外源性凝血途径及活化蛋白C（APC）的影响。方法采用单中心前瞻性研究方法，选择2009年11月至2014年10月北京大学人民医院重症加强治疗病房（ICU）收治的行液体复苏治疗的感染性休克患者84例，按随机数字表法分为两组，乳酸林格液组（RL组，40例）应用乳酸林格液扩容，羟乙基淀粉组（HES组，44例）应用羟乙基淀粉130／0．4扩容。复苏前及复苏后6、12、24h取血，测定凝血酶原时间（PT）、组织因子（TF）、组织因子途径抑制物（TFPI）及APC，同时记录患者住院时间及病死率。结果RL组液体复苏前后胛、TF、TFPI及APC均无明显改变；HES组复苏后PT也无明显改变，且两组间差异无统计学意义。HES组复苏后TF逐渐降低，并于24h时明显低于复苏前（U／L：15．80±7．32比31．40±2．75，P〈0．05）；但各时间点与RL组比较差异均无统计学意义（均P〉0．05）。HES组复苏后12h、24h时TFPI较复苏前略有升高（μg/L：1．32±0．22、1．14±0．09比0．63±0．54），且高于RL组同时间点（μg／L：0．84±0．69、0．95±0．30），但组内及组间比较差异均无统计学意义（均P〉0．05）。HES组复苏后APC逐渐降低，且复苏后6、12、24h时明显低于RL组（mg／L：3．38±3．00比5．98±4．12，3．31±1．94比5．33±3．71，3．42±2．64比7．53±4．67，P〈0．05或P〈0．01）。HES组ICU住院时间明显短于RL组（d：12．50±8．83比17．10±16．60，t=9．037，P〈0．001），但病死率差异无统计学意义[40．9％（18／44）比60．0％（24／40），χ^2=2．339，P=0．126]。结论应用乳酸林格液或羟乙基淀粉进行液体复苏对患者的阳均无明显影响；但羟乙基淀粉可能会抑制外源性凝血途径的过度激活，同时对蛋白C的活化也存在抑制作用。
Objective To investigate the influence of hydroxyethyl starch solution on exogenous coagulation and active protein C （APC） in the patients with septic shock. Methods A single-center prospective study was conducted. Eighty-four consecutive patients with septic shock admitted to intensive care unit （ICU） of Peking University People＇s Hospital from November 2009 to October 2014 were enrolled. The patients were randomized into two study groups by random digits table： Ringer lactate solution group （RL group, n = 40） and hydroxyethyl starch group （HES group, n = 44）, and Ringer lactate solution or hydroxyethl starch 130/0.4 was used for resuscitation respectively. Peripheral blood was collected at four time points： before resuscitation, 6, 12, and 24 hours after resuscitation. The prothrombin time （PT）, tissue factor （TF）, tissue factor pathway inhibitor （TFPI） and APC were determined, and the length of ICU stay and the mortality were recorded. Results There were no significant differences in PT, TF, TFPI, and APC before and after resuscitation in RL group. No change in PT was found after resuscitation in HES group, and no significant difference was found as compared with RL group. TF after resuscitation in HES group was decreased gradually, and the level at the 24 hours after resuscitation was significantly lower than that before resuscitation （U/L： 15.80±7.32 vs. 31.40±2.75, P 〈 0.05）; but there was no significant difference at all time points when compared with that of RL group （all P 〉 0.05 ）. TFPI at 12 hours and 24 hours after resuscitation in HES group was increased when compared with before resuscitation （μg/L： 1.32±0.22, 1.14±0.09 vs. 0.63±0.54）. TFPI in HES group was significantly higher than that in RL group （μg/L： 0.84±0.69, 0.95±0.30）, but there was no significant differences between two groups （both P 〉 0.05 ）. APC after resuscitation in HES group was decreased gradually, which was significantly lower than that in RL group at 6, 12
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2015年第1期28-32,共5页
Chinese Critical Care Medicine
基金
国家临床重点专科建设项目（2011-872）
北京大学人民医院研究与发展基金（RDC2009-01）
