|本期目录/Table of Contents|

[1]胡艳晶,宋景春,李单,等.大黄治疗脓毒症性凝血病的单中心回顾性病例对照研究[J].医学研究与战创伤救治(原医学研究生学报),2022,24(1):13-17.[doi:10.3969/j.issn.1672-271X.2022.01.003]
　HU Yan-jing,SONG Jing-chun,LI Dan,et al.Effect of rhubarb in the treatment of sepsis-induced coagulopathy: A single-center retrospective case-control study[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(1):13-17.[doi:10.3969/j.issn.1672-271X.2022.01.003]
点击复制

大黄治疗脓毒症性凝血病的单中心回顾性病例对照研究()
分享到62.8K

《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年1期
页码:
13-17
栏目:
临床研究
出版日期:
2022-02-20

文章信息/Info

Title:
Effect of rhubarb in the treatment of sepsis-induced coagulopathy: A single-center retrospective case-control study
作者:
胡艳晶; 宋景春; 李单; 余甜; 李兆芳; 何龙平; 林青伟; 邓星平
作者单位：330002南昌，江西中医药大学(胡艳晶); 330002南昌，解放军联勤保障部队第九○八医院重症医学科（宋景春、余甜、李兆芳、何龙平、林青伟、邓星平）;330002 南昌，江西省军区第三干休所（李单）
Author(s):
HU Yan-jing;  SONG Jing-chun;  LI Dan;  YU Tian;  LI Zhao-fang;  HE Long-ping;  LIN Qing-wei;  DENG Xing-ping
(1. Jiangxi University of Traditional Chinese Medicine，Nanchang 330002, Jiangxi, China;2. Intensive Care Unit, the 908th Hospital of the Joint Logistics Support Force，PLA，Nanchang 330002, Jiangxi, China;3. The Third Cadre Sanatorium of Jiangxi Military Region, Nanchang 330002, Jiangxi, China)
关键词:
脓毒症; 凝血病; 大黄; 血栓弹力图
Keywords:
sepsis;  coagulopathy;  rhubarb;  thrombelastography
分类号:
R278
DOI:
10.3969/j.issn.1672-271X.2022.01.003
文献标志码:
A
摘要:
目的探讨中药大黄对脓毒症性凝血病(SIC)患者的治疗作用。方法回顾性分析2018年1月至2019年12月解放军联勤保障部队第九○八医院重症医学科收治的40例SIC患者，按是否接受大黄治疗分为大黄治疗组(n=20)和对照组(n=20)，收集患者临床资料，包括白细胞计数、血小板计数、C反应蛋白、血浆凝血酶原时间（PT）、活化部分凝血活酶原时间（APTT），纤维蛋白原（FIB）、凝血酶时间（TT）、纤维蛋白降解产物（FDP）、D-二聚体（DD）以及血栓弹力图（TEG）参数，并进行统计学分析。结果大黄治疗组和对照组的90 d生存率比较差异无统计学意义（P＞0.05）。用药后第3天，大黄治疗组患者的FIB水平[（2.92±0.99）g/L]和TEG-MA[（57.8±6.0）mm]显著高于对照组患者的FIB水平[（2.14±1.01）g/L]和TEG-MA[（49.3±9.2）mm（P<0.05）]。用药后第5天，大黄治疗组患者的[TEG-MA（59.5±9.0）mm]显著高于对照组患者第5天的TEG-MA值[（46.9±16.4）mm]（P<0.05）。结论大黄可以改善SIC患者纤维蛋白原水平和血小板功能，但不影响SIC患者的90d生存率。
Abstract:
ObjectiveTo investigate the effect of rhubarb on patients with sepsis-induced coagulopathy (SIC).MethodsThe clinical data of 40 patients with SIC admitted to the Department of Critical Care Medicine of the 908th Hospital of PLA from January 2018 to December 2019 were collected, which include white blood cell count, platelet count, C-reactive protein, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), thrombin time (TT), fibrin degradation products (FDP), D-dimer (DD) and thrombelastography (TEG) items. Patients with SIC were divided into rhubarb treatment group (n=20) and control group (n=20) according to whether receiving rhubarb, and then statistical analysis was performed.ResultsThere was no significant difference at the 90-day survival rate of SIC patients between the rhubarb treatment group and the control group (P>0.05). On the third day after treatment, the FIB levels [(2.92±0.99)g/L] and TEG-MA values [(57.8±6.0)mm] of the rhubarb treatment group were significantly higher than the FIB levels[(2.14±1.01) g/L] and TEG-MA values [(49.3±9.2)mm] of the control group (P<0.05). On the 5th day after treatment, the TEG-MA values [(59.5±9.0) mm] of the rhubarb treatment group were significantly higher than the TEG-MA values [(46.9±16.4) mm] of the control group (P<0.05).ConclusionRhubarb can increase the fibrinogen levels and enhance platelet function of SIC patients, but it has no effect on the 90-day survival rate of SIC patients.

参考文献/References:

[1]Lin JJ, Hsiao HJ, Chan OW, et al. Increased serum thrombomodulin level is associated with disease severity and mortality in pediatric sepsis[J]. PLoS One, 2017, 12 (8):e0182324.
[2]Iba T, Levi M, Levy JH. Sepsis-induced coagulopathy and disseminated intravascular coagulation[J]. Semin Thromb Hemost,2020,46(1):89-95.
[3]Kim SM, Kim SI, Yu G, et al. Role of thromboelastography as an early predictor of disseminated intravascular coagulation in patients with septic shock[J]. J Clin Med, 2020, 9(12):3883.
[4]Iba T, Levy JH, Warkentin TE, et al. Diagnosis and management of sepsis-induced coagulopathy and disseminated intravascular coagulation[J]. J Thromb Haemost,2019,17(11):1989-1994.
[5]张莉,潘婧,吴欢.大黄化学成分及抗氧化、酶抑制特性研究进展[J].海南医学,2019,30(20):2683-2686.
[6]金丽霞,金丽军,栾仲秋,等.大黄的化学成分和药理研究进展[J].中医药信息, 2020, 37(1):121-126.
[7]Yuan JB, Wang FY, Ming LI, et al. Determination of Rhein in Plasma by SPE-HPLC and Its Pharmacokinetic Study in Rats[J]. ChinJExpTradMedFormul, 2011，17(18):140-143.
[8]高红刚,周菊华.大黄素抗炎作用及相关机制研究进展[J].济宁医学院学报,2016,39(5):348-352.
[9]刘晗，高云.大黄素药理作用的分子机制研究进展[J].中国药理学通 报,2009,25(12):1552-1555.
[10]Pan TL, Wang PW, Huang CH, et al. Herbal formula, scutellariae radix and rheirhizoma attenuate dimethylnitrosamine-induced liver fibrosis in a rat model[J].Sci Rep,2015,5:11734.doi: 10.1038/srep11734.
[11]林青伟,曾庆波,宋景春.大黄素治疗脓毒症性凝血功能紊乱的研究进展[J].实用休克杂志(中英文),2018,2(5):301-304.
[12]Tang N，Bai H，Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy[J]. J Thromb Haemost,2020,18(5):1094-1099.
[13]林青伟,宋景春,曾庆波,等.大黄素对脓毒症大鼠凝血紊乱治疗的作用[J].东南国防医药,2018,20(5):464-470.
[14]Vilar R,Lukowski SW,Garieri M, et al. Chemical Modulators of Fibrinogen Production and Their Impact on Venous Thrombosis[J].Thromb Haemost,2020，121(4):433-448.
[15]Gaertner F, Massberg S. Blood coagulation in immunothrombosis-At the frontline of intravascular immunity[J].Semin Immunol,2016,28(6):561-569.
[16]Luo C，Hu H，Gong J, et al. The value of thromboelastography in the diagnosis of sepsis-induced coagulopathy[J]. Clin Appl Thromb Hemost, 2020, 26:1076029620951847.doi: 10.1177/1076029620951847.
[17]王磊,张静泽,高文远.大黄活性成分药代动力学研究进展[J].中成药,2011,33(9):1571-1574.
[18]曾庆波,宋景春,钟林翠,等.不同给药方式对危重症合并急性胃肠损伤患者大黄血药浓度影响[J].临床军医杂志,2019,47(7):710-711.

相似文献/References:

[1]张 丽,侯毅翰,张民伟,等.降钙素原在血流感染中的临床应用分析[J].医学研究与战创伤救治(原医学研究生学报),2013,15(06):603.[doi:10.3969/j.issn.1672-271X.2013.06.016]
　ZHANG Li,HOU Yi-han,ZHANG Min-wei,et al.Cost-effective analysis of procalcitonin in the diagnosis of bloodstream infection[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2013,15(1):603.[doi:10.3969/j.issn.1672-271X.2013.06.016]
[2]黄凤楼,刁孟元,钱海飞,等.降钙素原及内毒素对腹腔感染脓毒症患者预后的评估[J].医学研究与战创伤救治(原医学研究生学报),2014,16(02):147.[doi:10.3969/j.issn.1672-271X.2014.02.011]
　HUANG Feng-lou,DIAO Meng-yuan,QIAN Hai-fei,et al.Prognostic value of procalcitonin and endotoxin concentrations for intra-abdominal sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2014,16(1):147.[doi:10.3969/j.issn.1672-271X.2014.02.011]
[3]刘 瑜,方 放,黄 方.糖皮质激素受体基因多态性与脓毒症临床转归的相关性研究[J].医学研究与战创伤救治(原医学研究生学报),2015,17(06):575.[doi:10.3969/j.issn.1672-271X.2015.06.005]
　LIU Yu,FANG Fang,HUANG Fang..Association of polymorphisms in glucocorticoid receptor with outcome of sepsis in a Chinese Han population[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2015,17(1):575.[doi:10.3969/j.issn.1672-271X.2015.06.005]
[4]郭剑,雷洁洁,章柏平,等.脓毒症患者连续性肾替代治疗时机选择及预后比较[J].医学研究与战创伤救治(原医学研究生学报),2018,20(01):37.[doi:10.3969/j.issn.1672-271X.2018.01.008]
　GUO Jian,LEI Jie-jie,ZHANG Bo-ping,et al.Comparison of timing and prognosis of continuous renal replacement therapy in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(1):37.[doi:10.3969/j.issn.1672-271X.2018.01.008]
[5]窦燕,郭以河,孔晓飞,等.创伤弧菌脓毒症1例报道并文献复习[J].医学研究与战创伤救治(原医学研究生学报),2018,20(01):76.[doi:10.3969/j.issn.1672-271X.2018.01.018]
[6]李勇,宋薇.连续性血液净化联合益气活血法对脓毒症伴心肌功能障碍患者的临床疗效观察[J].医学研究与战创伤救治(原医学研究生学报),2018,20(03):225.[doi:10.3969/j.issn.1672-271X.2018.03.001]
　LI Yong,SONG Wei.The clinical efficacy of continuous blood purification combined with Yiqi Huoxue for the sepsis patients with myocardial dysfunction[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(1):225.[doi:10.3969/j.issn.1672-271X.2018.03.001]
[7]林青伟,宋景春,曾庆波,等.大黄素对脓毒症大鼠凝血紊乱治疗的作用[J].医学研究与战创伤救治(原医学研究生学报),2018,20(05):464.[doi:10.3969/j.issn.1672-271X.2018.05.004]
　LIN Qing-wei,SONG Jing-chun,ZENG Qing-bo,et al.Effect ofemodin on coagulation disorders of septic rats[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2018,20(1):464.[doi:10.3969/j.issn.1672-271X.2018.05.004]
[8]谢醒文,杨振宁,葛鑫,等.脓毒症相关凝血功能障碍对脓毒症患者预后的评估价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(2):161.[doi:10.3969/j.issn.1672-271X.2020.02.011]
　XIE Xing wen,YANG Zhen ning,GE Xin,et al.A clinical research on relationship between sepsisassociated coagulopathy and prognosis in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(1):161.[doi:10.3969/j.issn.1672-271X.2020.02.011]
[9]钟林翠,宋景春,姜峻,等.血小板聚集率在评价脓毒症患者血小板功能及预后中的价值[J].医学研究与战创伤救治(原医学研究生学报),2020,22(3):249.[doi:10.3969/j.issn.1672-271X.2020.03.006]
　ZHONG Lin-cui,SONG Jing-chun,JIANG Jun,et al.Clinical study on platelet aggregation to evaluate platelet function and prognosis in patients with sepsis[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(1):249.[doi:10.3969/j.issn.1672-271X.2020.03.006]
[10]曾庆波,宋景春,钟林翠,等.严重创伤与脓毒症患者凝血功能紊乱的比较研究[J].医学研究与战创伤救治(原医学研究生学报),2020,22(4):367.[doi:10.3969/j.issn.1672-271X.2020.04.007]
　ZENG Qing-bo,SONG Jing-chun,ZHONG Lin-cui,et al.Comparation of coagulation dysfunction between severe trauma and sepsis patients[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2020,22(1):367.[doi:10.3969/j.issn.1672-271X.2020.04.007]

备注/Memo

备注/Memo:
基金项目：江西省卫生健康委科技计划（20204820）；江西中医药大学校级创新基金课题（JZYC20S18）
更新日期/Last Update: 2022-02-21