中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
4期
258-263
,共6页
周昕怡%李会%谢郭豪%方军%连燕虹%方向明
週昕怡%李會%謝郭豪%方軍%連燕虹%方嚮明
주흔이%리회%사곽호%방군%련연홍%방향명
血必净注射液%炎症反应%器官功能%围手术期%白细胞介素-6%高迁移率族蛋白B1
血必淨註射液%炎癥反應%器官功能%圍手術期%白細胞介素-6%高遷移率族蛋白B1
혈필정주사액%염증반응%기관공능%위수술기%백세포개소-6%고천이솔족단백B1
Xuebijing injection%Inflammatory response%Organ function%Perioperation%Interleukin-6%High mobility group protein B1
目的 探讨血必净注射液对开腹手术患者围手术期炎症反应的抑制和对器官功能的保护作用.方法 采用单肓、随机、平行对照研究方法,纳入浙江大学医学院附属第一医院年龄18 ～ 80岁、美国麻醉医师协会(ASA)病情评估分级Ⅰ～Ⅲ级、欲行择期开腹手术的患者60例,按随机数字列表法将患者分为对照组(30例)和治疗组(30例),分别在麻醉诱导后以2 mL/min的速度持续输注0.9％生理盐水200 mL或血必净注射液2 mL/kg+ 0.9％生理盐水100 mL.所有患者均于麻醉诱导前(T1)、术毕(T2)、术后12 h(T3)或术后3d凌晨5点(T4)取血,测定体温、血常规、C-反应蛋白(CRP)、肝肾功能、空腹血糖(Glu)以及血清白细胞介素-6(IL-6)、高迁移率族蛋白B1(HMGB1)水平,同时记录不良反应发生情况评价血必净的安全性.结果 治疗组T3时体温、T3与T1体温差值均较对照组明显降低(℃:36.70 ±0.37比37.38±0.47,t=6.199,P=0.000;0.07±0.50比0.85±0.58,t=5.598,P=0.000).两组患者术后白细胞计数、中性粒细胞比例、CRP均较术前明显升高,但两组间比较差异无统计学意义.与对照组比较,治疗组患者T3时丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)明显降低[ALT (U/L):17.56±9.80比88.60±179.76,AST(U/L):27.53±13.12比84.16±151.14,TBil(μmol/L):15.46±9.79比25.63±25.33,均P＜0.05];而两组结合胆红素(CB)、尿素氮(BUN)、肌酐(Cr)、Glu差异无统计学意义.两组术后IL-6均呈升高趋势,其中治疗组T2时IL-6水平(ng/L)明显低于对照组(41.42±59.74比124.84±119.66,t=3.405,P=0.001).两组T4时HMGB1水平均较T1时下降,仅治疗组下降差异有统计学意义(μg/L:22.03±15.73比45.09±33.79,P＜0.05);组间差异不明显.试验期间无严重不良反应事件发生.结论 开腹手术麻醉中应用血必净注射液能显著减轻围手术期炎症反应,对肝功能起到明显的保护作用,有利于恢复器官功能,改善预后,且安全有效.
目的 探討血必淨註射液對開腹手術患者圍手術期炎癥反應的抑製和對器官功能的保護作用.方法 採用單肓、隨機、平行對照研究方法,納入浙江大學醫學院附屬第一醫院年齡18 ～ 80歲、美國痳醉醫師協會(ASA)病情評估分級Ⅰ～Ⅲ級、欲行擇期開腹手術的患者60例,按隨機數字列錶法將患者分為對照組(30例)和治療組(30例),分彆在痳醉誘導後以2 mL/min的速度持續輸註0.9％生理鹽水200 mL或血必淨註射液2 mL/kg+ 0.9％生理鹽水100 mL.所有患者均于痳醉誘導前(T1)、術畢(T2)、術後12 h(T3)或術後3d凌晨5點(T4)取血,測定體溫、血常規、C-反應蛋白(CRP)、肝腎功能、空腹血糖(Glu)以及血清白細胞介素-6(IL-6)、高遷移率族蛋白B1(HMGB1)水平,同時記錄不良反應髮生情況評價血必淨的安全性.結果 治療組T3時體溫、T3與T1體溫差值均較對照組明顯降低(℃:36.70 ±0.37比37.38±0.47,t=6.199,P=0.000;0.07±0.50比0.85±0.58,t=5.598,P=0.000).兩組患者術後白細胞計數、中性粒細胞比例、CRP均較術前明顯升高,但兩組間比較差異無統計學意義.與對照組比較,治療組患者T3時丙氨痠轉氨酶(ALT)、天鼕氨痠轉氨酶(AST)、總膽紅素(TBil)明顯降低[ALT (U/L):17.56±9.80比88.60±179.76,AST(U/L):27.53±13.12比84.16±151.14,TBil(μmol/L):15.46±9.79比25.63±25.33,均P＜0.05];而兩組結閤膽紅素(CB)、尿素氮(BUN)、肌酐(Cr)、Glu差異無統計學意義.兩組術後IL-6均呈升高趨勢,其中治療組T2時IL-6水平(ng/L)明顯低于對照組(41.42±59.74比124.84±119.66,t=3.405,P=0.001).兩組T4時HMGB1水平均較T1時下降,僅治療組下降差異有統計學意義(μg/L:22.03±15.73比45.09±33.79,P＜0.05);組間差異不明顯.試驗期間無嚴重不良反應事件髮生.結論 開腹手術痳醉中應用血必淨註射液能顯著減輕圍手術期炎癥反應,對肝功能起到明顯的保護作用,有利于恢複器官功能,改善預後,且安全有效.
목적 탐토혈필정주사액대개복수술환자위수술기염증반응적억제화대기관공능적보호작용.방법 채용단황、수궤、평행대조연구방법,납입절강대학의학원부속제일의원년령18 ～ 80세、미국마취의사협회(ASA)병정평고분급Ⅰ～Ⅲ급、욕행택기개복수술적환자60례,안수궤수자렬표법장환자분위대조조(30례)화치료조(30례),분별재마취유도후이2 mL/min적속도지속수주0.9％생리염수200 mL혹혈필정주사액2 mL/kg+ 0.9％생리염수100 mL.소유환자균우마취유도전(T1)、술필(T2)、술후12 h(T3)혹술후3d릉신5점(T4)취혈,측정체온、혈상규、C-반응단백(CRP)、간신공능、공복혈당(Glu)이급혈청백세포개소-6(IL-6)、고천이솔족단백B1(HMGB1)수평,동시기록불량반응발생정황평개혈필정적안전성.결과 치료조T3시체온、T3여T1체온차치균교대조조명현강저(℃:36.70 ±0.37비37.38±0.47,t=6.199,P=0.000;0.07±0.50비0.85±0.58,t=5.598,P=0.000).량조환자술후백세포계수、중성립세포비례、CRP균교술전명현승고,단량조간비교차이무통계학의의.여대조조비교,치료조환자T3시병안산전안매(ALT)、천동안산전안매(AST)、총담홍소(TBil)명현강저[ALT (U/L):17.56±9.80비88.60±179.76,AST(U/L):27.53±13.12비84.16±151.14,TBil(μmol/L):15.46±9.79비25.63±25.33,균P＜0.05];이량조결합담홍소(CB)、뇨소담(BUN)、기항(Cr)、Glu차이무통계학의의.량조술후IL-6균정승고추세,기중치료조T2시IL-6수평(ng/L)명현저우대조조(41.42±59.74비124.84±119.66,t=3.405,P=0.001).량조T4시HMGB1수평균교T1시하강,부치료조하강차이유통계학의의(μg/L:22.03±15.73비45.09±33.79,P＜0.05);조간차이불명현.시험기간무엄중불량반응사건발생.결론 개복수술마취중응용혈필정주사액능현저감경위수술기염증반응,대간공능기도명현적보호작용,유리우회복기관공능,개선예후,차안전유효.
Objective To investigate the role of Xuebijing injection in inhibiting perioperative inflammatory responses and protecting the function of multiple organs.Methods A single-blind,randomized,parallel controlled trial was conducted.60 patients in the First Affiliated Hospital of Zhejiang University School of Medicine,aged 18 to 80 years,ASA grade Ⅰ-Ⅲ,undergoing elective abdominal surgery,were enrolled.The patients were randomly divided into the control group (n =30) and the treatment group (n =30).In the control group,after induction of anesthesia,a continuous infusion of 0.9％ normal saline (NS) 200 mL was given in a speed of 2 mL/min,while a continuous infusion of Xuebijing 2 mL/kg in 100 mL of 0.9％ NS was given at 2 mL/min in the treatment group after induction of anesthesia.The blood sample was drawn,and body temperature,routine blood test,C-reactive protein (CRP),liver and kidney function,fasting glucose (Glu),and serum interleukin-6 (IL-6),high mobility group protein B 1 (HMGB 1) levels were determined in all the patients before anesthesia (T1),at the end of operation (T2),12 hours after operation (T3),or at 5:00 am on the third day after operation (T4).At the same time the adverse reactions were recorded for evaluation of the safety of Xuebijing.Results After using Xuebijing injection,T3 body temperature and the T3-T1 temperature difference in treatment group were significantly lower than those of the control group(℃℃:36.70 ± 0.37 vs.37.38 ± 0.47,t＝6.199,P＝0.000; 0.07 ± 0.50 vs.0.85 ±0.58,t＝5.598,P＝0.000).Postoperative white blood cell count,neutrophil percentage,and CRP were significantly higher than those before the operation,but the differences between two groups were not statistically significant.Compared with the control group,alanine aminotransferase (ALT),aspartate transaminase (AST),total bilirubin (TBil) levels at T3 of treatment group were significantly reduced [ALT (U/L):17.56 ± 9.80 vs.88.60 ± 179.76,AST(U/L):27.53 ± 13.12 vs.84.16 ± 151.14,TBil(μ,mol/L):15.46 ± 9.79 vs.25.63 ± 25.33,all P＜0.05].Difference of conjugated bilirubin (CB),blood urea nitrogen (BUN),creatinine (Cr),Glu were not statistically significant between two groups.IL-6 showed an increasing trend after the operation in both groups,and IL-6 level (ng/L) at T2 of the treatment group was significantly lower than that of the control group (41.42 ± 59.74 vs.124.84 ± 119.66,t=3.405,P=0.001).The HMGB 1 level of two groups at T4 were lower than those at T1,but it decreased significantly only in treatment group (μg/L:22.03 ± 15.73 vs.45.09 ± 33.79,P＜0.05),and there was no significant difference between two groups.No serious adverse events occurred during the clinical trial.Conclusions Application of Xuebijing injection during anesthesia can significantly diminish postoperative inflammatory injury,which plays an important role in the protection of liver function,helps restore organ function and improve prognosis,and it is safe and effective.
