中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2015年
1期
28-32
,共5页
吕杰%李童%刘方%安友仲
呂傑%李童%劉方%安友仲
려걸%리동%류방%안우중
感染性休克%乳酸林格液%羟乙基淀粉%外源性凝血途径%活化蛋白C
感染性休剋%乳痠林格液%羥乙基澱粉%外源性凝血途徑%活化蛋白C
감염성휴극%유산림격액%간을기정분%외원성응혈도경%활화단백C
Septic shock%Ringer lactate solution%Hydroxyethyl starch%Exogenous coagulation%Active protein C
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PT、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24 h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12 h、24 h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),x2=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PT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.
目的 觀察羥乙基澱粉溶液複囌對感染性休剋患者外源性凝血途徑及活化蛋白C (APC)的影響.方法 採用單中心前瞻性研究方法,選擇2009年11月至2014年10月北京大學人民醫院重癥加彊治療病房(ICU)收治的行液體複囌治療的感染性休剋患者84例,按隨機數字錶法分為兩組,乳痠林格液組(RL組,40例)應用乳痠林格液擴容,羥乙基澱粉組(HES組,44例)應用羥乙基澱粉130/0.4擴容.複囌前及複囌後6、12、24h取血,測定凝血酶原時間(PT)、組織因子(TF)、組織因子途徑抑製物(TFPI)及APC,同時記錄患者住院時間及病死率.結果 RL組液體複囌前後PT、TF、TFPI及APC均無明顯改變;HES組複囌後PT也無明顯改變,且兩組間差異無統計學意義.HES組複囌後TF逐漸降低,併于24 h時明顯低于複囌前(U/L:15.80±7.32比31.40±2.75,P＜ 0.05);但各時間點與RL組比較差異均無統計學意義(均P＞0.05).HES組複囌後12 h、24 h時TFPI較複囌前略有升高(μg/L:1.32±0.22、1.14±0.09比0.63±0.54),且高于RL組同時間點(μg/L:0.84±0.69、0.95±0.30),但組內及組間比較差異均無統計學意義(均P＞0.05).HES組複囌後APC逐漸降低,且複囌後6、12、24h時明顯低于RL組(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組ICU住院時間明顯短于RL組(d:12.50±8.83比17.10± 16.60,t=9.037,P＜0.001),但病死率差異無統計學意義[40.9％ (18/44)比60.0％ (24/40),x2=2.339,P=0.126].結論 應用乳痠林格液或羥乙基澱粉進行液體複囌對患者的PT均無明顯影響;但羥乙基澱粉可能會抑製外源性凝血途徑的過度激活,同時對蛋白C的活化也存在抑製作用.
목적 관찰간을기정분용액복소대감염성휴극환자외원성응혈도경급활화단백C (APC)적영향.방법 채용단중심전첨성연구방법,선택2009년11월지2014년10월북경대학인민의원중증가강치료병방(ICU)수치적행액체복소치료적감염성휴극환자84례,안수궤수자표법분위량조,유산림격액조(RL조,40례)응용유산림격액확용,간을기정분조(HES조,44례)응용간을기정분130/0.4확용.복소전급복소후6、12、24h취혈,측정응혈매원시간(PT)、조직인자(TF)、조직인자도경억제물(TFPI)급APC,동시기록환자주원시간급병사솔.결과 RL조액체복소전후PT、TF、TFPI급APC균무명현개변;HES조복소후PT야무명현개변,차량조간차이무통계학의의.HES조복소후TF축점강저,병우24 h시명현저우복소전(U/L:15.80±7.32비31.40±2.75,P＜ 0.05);단각시간점여RL조비교차이균무통계학의의(균P＞0.05).HES조복소후12 h、24 h시TFPI교복소전략유승고(μg/L:1.32±0.22、1.14±0.09비0.63±0.54),차고우RL조동시간점(μg/L:0.84±0.69、0.95±0.30),단조내급조간비교차이균무통계학의의(균P＞0.05).HES조복소후APC축점강저,차복소후6、12、24h시명현저우RL조(mg/L:3.38±3.00비5.98±4.12,3.31±1.94비5.33±3.71,3.42±2.64비7.53±4.67,P＜ 0.05혹P＜0.01).HES조ICU주원시간명현단우RL조(d:12.50±8.83비17.10± 16.60,t=9.037,P＜0.001),단병사솔차이무통계학의의[40.9％ (18/44)비60.0％ (24/40),x2=2.339,P=0.126].결론 응용유산림격액혹간을기정분진행액체복소대환자적PT균무명현영향;단간을기정분가능회억제외원성응혈도경적과도격활,동시대단백C적활화야존재억제작용.
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 6,12,24 hours after resuscitation (mg/L:3.38±3.00 vs.5.98±4.12,3.31 ± 1.94 vs.5.33 ± 3.71,3.42 ± 2.64 vs.7.53 ± 4.67,P ＜ 0.05 or P ＜ 0.01).The length of ICU stay in HES group was significantly shorter than that in RL group (days:12.50 ± 8.83 vs.17.10± 16.60,t =9.037,P ＜ 0.001),but there was no significant difference in mortality between HES group and RL group [40.9％ (18/44) vs.60.0％ (24/40),x 2=2.339,P =0.126].Conclusions Both RL and hydroxyethyl starch fluid resuscitation did not affect the PT of the patients.The use of hydroxyethyl starch probably inhibits excessive activation of the exogenous coagulation and hyper-coagulation in the early stage of sepsis,and inhibits activation of protein C as well.
