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目的探讨联合应用血必净(XBJ)、钠洛酮(NX)干预重症胸腹损伤急性肝细胞功能损害的效果。方法以2009年1月~2013年6月在笔者医院就诊,创伤指数(TI)≥17分,除外合并颅脑损伤及在急诊死亡的重症胸腹创伤患者为入选标准,干预组112例,对照组57例;干预组患者在就诊及入院时分别检查谷丙转氨酶(ALT)、谷草转氨酶(AST)、肿瘤坏死因子-α(TNF-α)、内毒素(LPS)、白细胞介素-6(IL-6)、磷脂酶A2(PLA2),对照组仅于入院时进行同样项目检查。结果干预组患者就诊时ALT为328.43±21.35U/L,AST为298.49±19.62U/L;入院时ALT为58.12±11.67U/L,AST为54.72±10.31U/L。对照组患者入院时ALT为350.88±27.72U/L,AST为302.91±24.31U/L;干预后ALT、AST降低,与干预前及对照组相比差异有统计学意义P<0.01。结论联合应用XBJ与NX治疗可显著减轻重症胸腹损伤后急性肝细胞功能损害,对减少并发症、预防多器官功能障碍综合征(MODS)有重要意义。
Objective To investigate the effects of combined application of XBJ and NX on acute hepatic injury induced by severe thoracoabdominal trauma. Methods From January 2009 to June 2013, our hospital was visited and the traumatic index (TI) was ≥17, except for the patients with severe traumatic-abdominal injuries who had traumatic brain injury and died in emergency. The intervention group consisted of 112 patients (N = 57) were enrolled in the study. The patients in the intervention group were examined for ALT, AST, TNF-α, LPS and IL- IL-6) and phospholipase A2 (PLA2) in the control group were only checked on the same items at admission. Results The ALT of the intervention group was 328.43 ± 21.35U / L and the AST was 298.49 ± 19.62U / L. The admission ALT was 58.12 ± 11.67U / L and the AST was 54.72 ± 10.31U / L. The ALT in the control group was 350.88 ± 27.72U / L and the AST was 302.91 ± 24.31U / L at admission. The levels of ALT and AST in the control group were significantly lower than those before the intervention and in the control group (P <0.01). Conclusion Combined treatment with XBJ and NX can significantly reduce acute hepatotoxicity after severe thoracoabdominal injury, which is of great significance in reducing complications and preventing multiple organ dysfunction syndrome (MODS).