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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-Pro BNP)、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-Pro BNP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-Pro BNP与Cys水平较治疗前均下降,观察组治疗后NT-Pro BNP与Cys水平均低于对照组,差异有统计学意义(P<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(P<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(P>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-Pro BNP与Cys水平,临床上值得进一步研究。
Objective To investigate the curative effect of Shenfu injection combined with low molecular weight heparin on pediatric sepsis and its effect on plasma coagulation function and prognosis of NT-Pro BNP, Cystatin C (Cys) . Methods A total of 116 patients with sepsis who met the inclusion criteria were randomly divided into control group (58 cases) and observation group (58 cases). On the basis of routine treatment, the control group was given low molecular weight heparin, while the observation group was given Shenfu injection combined with low molecular weight heparin. Before and after treatment, APACHE, SOFA and Marshall scores were assessed in both groups. The levels of plasma NT-Pro BNP and Cys, the incidence of disseminated intravascular coagulation and multiple organ dysfunction syndrome and the 28-day mortality were measured. Results After 7 days of treatment, APACHE, SOFA and Marshall scores decreased in both groups, and the scores in the observation group were lower than those in the control group. Both PT and APTT decreased, FIB and PLT increased in both groups, And APTT were lower than the control group, FIB and PLT were higher than the control group; both groups NT-Pro BNP and Cys levels were lower than before treatment, the observation group after treatment NT-Pro BNP and Cys levels were lower than the control group, The difference was statistically significant (P <0.05). The incidence of DIC and MODS in the observation group were 10.3% and 13.8% respectively, while the control group was 25.9% and 31.0% respectively. The incidence of DIC and MODS in the observation group was lower than that in the control group (P <0.05) . The 28-day mortality rate was 32.8% in the control group and 24.1% in the observation group, but the difference was not statistically significant (P> 0.05). Conclusion Shenfu injection combined with low molecular weight heparin is an effective treatment for sepsis. It can significantly improve the coagulation function of patients and reduce the level of plasma NT-Pro BNP and Cys, which is worth further study.