目的:探讨参附注射液联合低分子肝素治疗小儿脓毒血症疗效及对患儿血浆N-末端脑钠肽前体(NT- ProBNP)、胱抑素C(Cys)凝血功能和预后的影响。方法116例符合纳入标准的脓毒血症患者,随机分为对照组58例和观察组58例。常规治疗的基础上,对照组给予低分子肝素治疗,观察组给予参附注射液联合低分子肝素治疗。治疗前后两组患者评定APACHE、SOFA、Marshall评分,检测凝血功能、血浆NT- ProBNP与Cys水平、弥散性血管内凝血与多器官功能障碍综合征发生率及28 d病死率。结果治疗7 d后,两组患者APACHE、SOFA及Marshall评分均有不同程度下降,观察组上述评分低于对照组患者;两组患者PT和APTT均下降, FIB和PLT均升高,观察组PT和APTT均低于对照组,FIB和PLT均高于对照组;两组患者NT- ProBNP与Cys水平较治疗前均下降,观察组治疗后NT- ProBNP与Cys水平均低于对照组,差异有统计学意义(<0.05)。观察组DIC发生率与MODS发生率分别为10.3%与13.8%,对照组分别为25.9%与31.0%,观察组DIC与MODS发生率均低于对照组,差异有统计学意义(<0.05)。对照组28 d病死率为32.8%,观察组仅为24.1%,但差异无统计意义(>0.05)。结论参附注射液联合低分子肝素是脓毒血症的一种有效治疗方案,可以明显改善患者的凝血功能,降低血浆NT- ProBNP与Cys水平,临床上值得进一步研究。
Objective To study clinical efficacy of Shenfu injection combined with low molecular weight heparin (LMWH) and the effect on serum NT-ProBNP, cystatin C (Cys), coagulation function and prognosis in children with pyemia. Methods A total of 116 children with pyemia were collected and randomly divided into control group ( =58) and observation group ( =58). The control group was treated with LMWH and the observation group was treated with Shenfu injection and LMWH besides conventional treatments. Then, the scores of APACHE, SOFA and Marshall, the coagulation function, levels of NT-ProBNP and Cys, incidences of disseminated intravascular coagulation (DIC) and mul tiple organ dysfunction syndrome (MODS) and mortality of the 2 groups were compared. Results After treatment for 7 days, the scores of APACHE, SOFA and Marshall were significantly decreased. The scores of of APACHE, SOFA and Marshall in the observation group were significantly lower than those in the control group ( < 0.05). PT and APTT were significantly shortened and the levels of FIB and PLT were significantly increased in both groups 7 days after treatments. PT and APTT were shorter and the levels of FIB and PLT were higher in the observation group than in the control group ( < 0.05). After treatment for 7 days, the levels NT-ProBNP and Cys were significantly decreased in both groups. The levels of NT-ProBNP and Cys in the observation group were significantly lower than those in the control group ( < 0.05). The incidences of DIC and MODS were 10.3% and 13.8% in the observation group, which were significantly lower than those of the control group (25.9%and 31.0%, < 0.05). The mortality of the observation group and the control group were 24.1% and 32.8%respectively, which were not significantly different ( > 0.05). Conclusions Combined treatments of Shenfu injection and LMWH is effective for pyemia in children, can improve the coagulation function, decrease the levels NT-ProBNP and Cys. It is worthy of further study.