张云海 邓梦华 马明远

【摘 要】 目的：觀察中西医结合治疗对热毒型脓毒症患者炎性反应和预后的影响。方法：选择86例脓毒症患者，随机分成对照组（42例）和观察组（44例）。对照组按2012年SSC国际脓毒症指南方案治疗，同时应用物理降温方式将患者体温控制在33～35℃;观察组在对照组的基础上静滴血必净注射液。评估治疗前及治疗5 d后两组序贯器官衰竭估计评分（SOFA）和急性生理与慢性健康评分（APACHEⅡ评分），并检测纤维蛋白原（FbgC）、活化部分凝血活酶时间（APTT）、血清肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）和白介素-10（IL-10）水平，统计两组ICU住院时间和28 d死亡率。结果：两组血清TNF-α、IL-6和IL-10水平均较治疗前降低（P<0.05），而观察组各因子水平显著低于对照组（P<0.05）。观察组治疗后的APTT较治疗前及对照组缩短（P<0.05）。两组出血事件发生率差异无统计学意义（P>0.05）。观察组治疗后的SOFA评分和APACHEII评分较对照组显著下降（P<0.05）。两组的ICU住院时间和28 d死亡率差异无统计学意义（P>0.05）。结论：血必净注射联合控温措施的中西医结合治疗手段可调节脓毒症热毒型患者的凝血功能，降低炎症反应，从而起到保护器官功能的作用。

【关键词】 中西医结合治疗;亚低温治疗;脓毒症;凝血功能;炎症反应

【中图分类号】R63【文献标志码】 A 【文章编号】1007-8517（2021）07-0100-05

Clinical Observation on the Efficacy of the Integrated Chinese and Western Treatment in Patients with Sepsis（Heat Toxin Type）

ZHANG Yunhai DENG Menghua MA Mingyuan*

ICU，Foshan Hospital of TCM， Foshan 528000，China

Abstract：Objective To observe the efficacy and prognosis of the integrated Chinese and western treatment in Patients with Sepsis（heat toxin type）. Methods 86 cases of patients with sepsis were randomly divided into the control group（n=42） and the observation group （n=44）.Patients in the control group were treated according to the Surviving sepsis campaign 2012，accepted mild hypothermia treatment（MHT） with temperature controlled in 33℃～35℃，While observation group were given intravenous administration of xuebijing injection on the basis of the control group.The APACHEII scores， FbgC，APTT， serum levels of TNF-a，IL-6，IL-10 were measured before and after treatment between the two groups， ICU stay and 28-day mortality rate were analyzed. Results The levels of TNF-a，IL-6 and IL-10 were significantly decreased in the two groups（P<0.05），while the observation group was significantly lower than the control group（P<0.05）. After treatment， APTT in the control group prolonged obviously （P<0.05）.APTT in the observation group was shorter than that before treatment and in the control group （P<0.05）.There was no significant difference on the incidence of bleeding events between the two groups （P>0.05）.SOFA and APACHEII scores in the observation group were significantly lower than the control group（P<0.05）， was significantly shorter in the combination group（P<0.05）.TheICU stay and 28-day mortality rates were no significant difference（P>0.05）.Conclusion The method of Xuebijing injection combined with temperature control in septic patients （heat toxin type） can regulate the coagulation function of， reduce the inflammatory reaction， and play a role in protecting organ function.

Key：words：Integrative Medical Treatment ;Mild Hypothermia Therapy（MHT）; Sepsis; Coagulation Function;Inflammatory

脓毒症（Sepsis）指由感染引起的全身炎症反应综合征（Systemic inflammatory response syndrome，SIRS），是引起多器官功能障碍（Multiple organ dysfunction syndrome，MODS）最主要的病理学基础和根本原因，而促炎与抑炎失衡是Sepsis发生发展的重要环节和病理基础[1]。医学界一直致力于研究有效的治疗手段，然而Sepsis死亡的绝对数字仍呈上升趋势，已成为临床急危重病患者死亡的主要原因之一[2]。Sepsis在中医学中并没有相关病名记载，由于其主要临床表现为发热，故多将Sepsis归入“热病”范畴。刘清泉教授[3]认为热毒内盛是脓毒症的重要发病基础，应用血必净注射液治疗Sepsis热毒型患者具有良好的疗效[4]。……