目的:评价凝血和血小板功能分析仪(Sonoclot)对重症中暑并发弥散性血管内凝血(disseminated intravascular coagulation,DIC)的诊断价值。方法 :回顾性的分析重症中暑合并凝血功能障碍患者,依据国际血栓与止血委员会(international socienty of thrombosis and hemostasis,ISTH)评分分为显性DIC组22例,非显性DIC组21例,比较两组患者一般临床资料,进行常规凝血指标、血常规、D-二聚体、Sonoclot仪器指标检测。利用单因素Logistic回归分析对Sonoclot指标(ACT、CR、PF)与患者是否发生DIC进行分析。ROC曲线分析评价Sonoclot仪器指标的DIC诊断价值。结果:两组之间在年龄、性别、中心体温、住院时间之间无差异,ICU住院时间、DIC症状、预后、ISTH评分、APACHEⅡ评分在两组之间差异有统计学意义(P<0.05)。Sonoclot仪器各量化指标ACT、CR与DIC的发生具有良好的相关性(P<0.05),ACT、ACT联合CR在ROC曲线下面积分别为0.854和0.877,差异有统计学意义(P<0.01),ACT诊断DIC特异性为69.2%,敏感性为90.3%,当ACT联合CR后,敏感性上升至80.2%,特异性为93.5%。结论:Sonoclot分析仪能够对重症中暑DIC作出快速诊断,成为临床诊断DIC的有效选择。
OBJECTIVE： To investigate the curative effects of Xuebijing （XBJ） injection, a Chinese patent medi- cine, on severe pulmonary contusion （PC）. METHODS： Sixty-three patients with PC were ran- domized to conventional therapy plus XBJ injec- tion （n=33） or conventional therapy alone （n=30）. Between groups differences in corticosteroid treat- ment, immune regulation therapy, hemofiltration, infusion volume, transfusion volume and antibiotic period were measured, as were intensive care unit（ICU）-free time, ventilation time, 28-day mortality rate and incidence of ventilation-associated pneu- monia （VAP）. Serum concentrations of procalcito- nin （PCT）, tumor necrosis factor-a （TNF-a）, interleu- kin （IL）-6, and 11_-10, white blood cell （WBC） counts and percentages of human leukocyte antigen DR/ CD14＋ （HLA-DR/CD14＋） peripheral blood mononu- clear cells were compared. Markers of ventilation were determined by blood gas analysis and ventila- tor parameters. RESULTS： WBC counts and serum concentrations of PCT, TNF-a, 11.-6 and IL-10 were reduced signifi- cantly more quickly, and CD14＋ percentage was in- creased significantly earlier, in the XBJ group than in the control group （P〈0.05 each）. The level of ven- tilation and oxygenation index were ameliorated earlier in the XBJ than in the control group （P〈 0.05）. XBJ treatment significantly reduced ICU-free time, ventilation time and incidence of VAP （P〈0.05 each）, but had no effect on 28-day mortality rate （P〉0.05）. CONCLUSION： XBJ treatment can shorten ICU-free and ventilation times and reduce the incidence of VAP, improving outcomes in patients with severe PC. XBJ may act by regulating inflammation and im- munity, alleviating systemic inflammatory response syndrome induced by trauma.
Yi ChenHuasheng TongWang ZhangXingqin ZhangZhigguo PanJunming QiuRuihuan PanLei Su
OBJECTIVE： To evaluate the effects of Xuebijing （XBJ） injection in heat stroke （HS） rats and to inves- tigate the mechanisms underlying these effects. METHODS： Sixty anesthetized rats were random- ized into three groups and intravenously injected twice daily for 3 days with 4 mL XBJ （XBJ group） or phosphate buffered saline （HS and Sham groups） per kg body weight. HS was initiated in the HS and XBJ groups by placing rats in a simulated climate chamber （ambient temperature 40℃：, humidity 60% ）. Rectal temperature, aterial pressure, and heart rate were monitored and recorded. Time to HS onset and survival were determined, and serum concentrations of tumor necrosis factor （TNF）-α, in-terleukin （IL）-1β, IL-6, alanine-aminotransferase （ALT）, and aspartate-aminotransferase （AST） were measured. Hepatic tissue was harvested for patho- logical examination and electron microscopic ex- amination. Kupffer cells （KCs） were separated from liver at HS initiation, and the concentrations of se- creted TNF-α, IL-1β3 and IL-6 were measured. RESULTS： Time to HS onset and survival were signif- icantly longer in the XBJ than in the HS group. Moreover, the concentrations of TNF-α, IL-1β, IL-6, ALT and AST were lower and liver injury was milder in the XBJ than in the HS group. Heat-stress in- duced structural changes in KCs and hepatic cells were more severe in the HS than in the XBJ group and the concentrations of TNF-α, IL-1β and IL-6 se- creted by KCs were lower in the XBJ than in the HS group. CONCLUSION： XBJ can alleviate HS-induced sys- temic inflammatory response syndrome and liver injury in rats, and improve outcomes. These protec- tive effects may be due to the ability of XBJ to inhib- it cytokine secretion by KCs.
Yi ChenHuasheng TongXingqin ZhangLiqun TangZhiguo PanZhifeng LiuPengkai DuanLei Su
