摘要
目的探讨重组人血小板生成素(rhTPO)治疗脓毒症伴血小板减少症的效果及其对炎症因子、凝血功能和血清血小板计数(Plt)、肌酸激酶(CK)、肌钙蛋白I(cTnI)水平的影响。方法采用前瞻性分析方法,选取2018年4月至2020年4月该院收治的脓毒症伴血小板减少症患者70例,采用随机数字表法分为观察组和对照组,每组35例。对照组给予综合疗法,观察组加用rhTPO治疗,疗程均为10 d。比较两组患者治疗前后急性生理和慢性健康估测Ⅱ(APACHEⅡ)评分、炎症因子、凝血功能及血清CK、cTnI水平和治疗1、3、5、7、10 d各时间点血清Plt等,记录两组患者机械通气时间、重症监护病房(ICU)住院时间、总住院时间、血液成分输注量及28 d病死率等。结果两组患者治疗后血清可溶性CD40配体、白细胞介素-6、血管性血友病因子、肿瘤坏死因子-α水平均较治疗前明显降低,且观察组患者治疗后明显低于对照组,差异均有统计学意义(P<0.05);两组患者治疗后APACHEⅡ评分及凝血酶原时间、纤维蛋白原、CK、cTnI水平比较,差异均无统计学意义(P>0.05)。观察组患者治疗1、3 d血清Plt与对照组比较,差异均无统计学意义(P>0.05);治疗5、7、10 d血清Plt均明显高于对照组,差异均有统计学意义(P<0.05)。两组患者机械通气时间、ICU住院时间、总住院时间比较,差异均无统计学意义(P>0.05);观察组患者血浆、浓缩红细胞、血小板输注量均明显少于对照组,差异均有统计学意义(P<0.05);两组患者28 d病死率比较,差异无统计学意义(P>0.05)。两组患者用药过程中均未发生头晕、高血压、头痛、骨骼疼痛等不良反应。结论rhTPO联合常规治疗脓毒症伴血小板减少症效果满意,可快速恢复患者Plt和改善炎症指标,但对患者凝血功能、血清CK和cTnI水平无明显影响,也不能降低患者28 d病死率。
Objective To explore the therapeutic effect of recombinant human thrombopoietin(rhTPO)in the treatment of sepsis complicating thrombocytopenia and its influence on the patients’inflammatory factors,coagulation function,serum platelet count(Plt),creatine kinase(CK)and troponin(cTnI)levels.Methods Using the prospective analysis method,70 patients with sepsis complicating thrombocytopenia admitted to this hospital from April 2018 to April 2020 were selected and divided into the observation group and control group by adopting the random number method,35 cases in each group.The control group was given the comprehensive therapy,and the observation group was added with the rhTPO therapy.The course of treatment was 10 d.The acute physiology and chronic healthⅡ(APACHEⅡ)score,inflammatory factor levels,blood coagulation function,serum CK and cTnI levels before and after treatment,serum Plt levels at each time point(on 1,3,5,7,10 d of treatment)were compared between the two groups.Moreover,the mechanical ventilation time,duration of stay in the intensive care unit(ICU),total hospitalization duration,amount of blood components infusion and the 28 d mortality rate were recorded in the two groups.Results Serum soluble CD40 ligand(sCD40L),interleukin-6(IL-6),von Willebrand factor(vWF)and tumor necrosis factor-α(TNF-α)levels after treatment in the two groups were significantly decreased compared with those before treatment,moreover which after treatment in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05);there was no statistically significant difference in the APACHEⅡscore,prothrombin time(PT),fibrinogen(Fg),CK and cTnI levels after treatment between the two groups(P>0.05);serum Plt level on 1,3 d of treatment had no statistically significant difference between the observation group and control group(P>0.05),the serum Plt levels on 5,7,10 d of treatment were significantly higher than those in the control group,and the differences w
作者
丁李诚
钱鑫锋
孙炜
DING Licheng;QIAN Xinfeng;SUN Wei(Department of Emergency,Affiliated Hospital of Jiangnan University,Wuxi,Jiangsu 214000,China)
出处
《重庆医学》
CAS
2022年第13期2282-2287,共6页
Chongqing medicine
