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目的观察清热化瘀汤对严重脓毒症患者凝血功能及预后的影响,为其临床运用提供依据。方法选择72例2010年至2012年于清远市中医院ICU住院的严重脓毒症患者,随机分为治疗组(38例)和对照组(34例),两组均按照指南要求给予常规治疗,治疗组于常规治疗基础上加用清热化瘀汤治疗。治疗前及治疗7 d后两组均检测PLT、PT、APTT、FIB、D-D等凝血相关指标,并记录APACHE-Ⅱ评分,随访统计住院天数及28 d病死率。结果 (1)与治疗前比较,治疗后治疗组PLT、PT、APTT、FIB、D-D等凝血指标均有改善(P均<0.01),对照组仅PLT、FIB、D-D有改善(P均<0.01);且治疗后,治疗组PLT、FIB高于对照组(P均<0.05),PT、APTT、D-D低于对照组(P均<0.05)。(2)治疗后两组APACCHE-Ⅱ评分均下降(P均<0.01),且治疗组低于对照组(P<0.05)。(3)两组住院天数相近。(4)两组28 d病死率差异无统计学意义(P>0.05)。结论清热化瘀汤可通过改善严重脓毒症患者的凝血功能而改善预后。
Objective To observe the effect of Qingre Huayu Decoction on the coagulation function and prognosis of patients with severe sepsis and provide the basis for its clinical application. Methods Seventy-two patients with severe sepsis who were hospitalized in ICU of Qingyuan Hospital of Traditional Chinese Medicine from 2010 to 2012 were randomly divided into treatment group (38 cases) and control group (34 cases). Both groups were given routine treatment as required by the guidelines, The treatment group was treated with Qingre Huayu Decoction on the basis of routine treatment. Before treatment and 7 days after treatment, coagulation-related indexes such as PLT, PT, APTT, FIB and D-D were detected in both groups. The APACHE-Ⅱ score was recorded. The hospitalization days and 28-day mortality were followed up. Results (1) Compared with before treatment, the coagulation indexes of PLT, PT, APTT, FIB and DD in treatment group were improved after treatment (all P <0.01), while only PLT, FIB and DD in control group were improved ). After treatment, the levels of PLT and FIB in the treatment group were higher than those in the control group (P <0.05), and the levels of PT, APTT and DD were lower than those in the control group (all P <0.05). (2) The APACCHE-Ⅱ scores decreased after treatment in both groups (all P <0.01), and the treatment group was lower than the control group (P <0.05). (3) The days of hospitalization in both groups are similar. (4) There was no significant difference in the 28-day mortality rate between the two groups (P> 0.05). Conclusion Qingre Huayu Decoction can improve the prognosis by improving the coagulation function in patients with severe sepsis.