曾庆波,宋景春,钟林翠,林青伟,胡艳晶

• 1:中国人民解放军联勤保障部队第九〇八医院

摘要(Abstract)：

目的研究大黄对脓毒症时凝血功能的影响并探讨其作用机制。方法选取脓毒症患者20例,于大黄给药前、给药后1、4、24 h采血,并检测白细胞计数、降钙素原、C反应蛋白(CRP)、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)、血浆纤维蛋白降解产物(FDP)、D-二聚体(DD)、抗凝血酶3(AT3)以及血栓弹力图。结果与4 h时比较,1 h和24 h时的DD明显升高,且差异有统计学意义(P <0.05);与4 h时比较,0 h、1 h、24 h时的Angle角和MA值均显著升高,但1 h时的K值明显缩短(P <0.05);与0 h相比,24 h的CRP明显降低(P <0.05)。结论脓毒症时,患者表现为DD的显著升高。大黄能够改善脓毒症患者的纤维蛋白原功能、血小板功能、纤溶功能,并能调控炎症反应。

关键词(KeyWords)： 脓毒症;大黄;凝血功能;血栓弹力图

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 曾庆波,宋景春,钟林翠,林青伟,胡艳晶

参考文献(References)：

• [1] Singer M,Deutschman CS,Seymour CW,et al. The third international consensus definitions for sepsis and Septic Shock(Sepsis3)[J]. JAMA,2016,315(8):801-810.
• [2]廖延年，黄骞，黎介寿.晚期糖基化终末产物受体在腹腔感染脓毒症中的研究进展[J].医学研究生学报，2015,28(6):96-100.
• [3] Levy MM,Dellinger RP,Townsend SR,et al. The surviving sepsis campaign:results of an international guideline-based performance improvement program targeting severe sepsis[J].Intensive Care Med,2010,36:222-231.
• [4] Yamakawa K,Yoshimura J,Ito T,et al. External validation of the two newly proposed criteria for assessing coagulopathy in sepsis[J]. Thromb Haemost,2018,28:20.
• [5] Levi M,Sivapalaratnam S. Disseminated intravascular coagulation:an update on pathogenesis and diagnosis[J]. Expert Rev Hematol,2018,11(8):663-672.
• [6]国家药典委员会.中华人民共和国药典（一部2010年版）[M].北京：工业出版社，2010:71.
• [7]金兰.大黄的药理作用及临床应用进展[J].中国医药指南，2013,11(11):487-488.
• [8]吴同辰，徐建如.生大黄治疗严重脓毒症疗效观察[J].现代中西医结合杂志，2009,18(30):3703-3704.
• [9]黄伟，陈肖.大黄对脓毒症患者肠道及凝血功能的影响[J].河南中医，2015,35(12),3037-3039.
• [10] Lance. A general review of major global coagulation assays:thrombelastography,thrombin generation test and clot waveform analysis[J]. Thromb J,2015,12(13):1.
• [11]宋景春.脓毒症合并弥散性血管内凝血的机制与监测[J].医学研究生学报，2017,30(7):703-708.
• [12] Ostrowski SR,Windelv NA,Ibsen M,et al. Consecutive thrombelastography clot strength profiles in patients with severe sepsis and their association with 28-day mortality:A prospective study[J]. J Crit Care,2013,28:317.
• [13] Haase N,Ostrowski SR,Wetterslev J,et al. Thromboelastography in patients with severe sepsis:A prospective cohort study[J]. Intensive Care Med,2015,41:77-85.
• [14] Syed Nabeel Muzaffar,Arvind Kumar Baronia,Afzal Azim,et al. Thromboelastography for evaluation of coagulopathy in nonbleeding patients with sepsis at intensive care unit admission[J]. Indian Journal of Critical Care Medicine,2017,21(5):268-273.
• [15] Rhodes A,Evans LE,Alhazzani W,et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Crit Care Med,2017,17:20.
• [16] Levi M,Schultz M,van der Poll T. Disseminated intravascular coagulation in infectious disease[J]. Semin Thromb Hemost,2010,36(4):367-377.
• [17]钟林翠，宋景春，曾庆波，等.血流感染相关脓毒症不同时相凝血功能紊乱的临床研究[J].医学研究生学报，2019,32(1):1267-1271.
• [18] Adamik B,Gozdzik W,Jakubczyk D,et al. Coagulation abnormalities identified by thromboelastometry in patients with severe sepsis:the relationship to endotoxemia and mortality[J].Blood Coagul Fibrinolysis,2017,28(2):163-170.
• [19]于学忠，姚咏明，周荣斌.中国脓毒症/脓毒性休克急诊治疗指南[J].中国急救医学，2018,38(9):741-756.
• [20]万兵，符海燕，张德厚.大黄对脓毒症的治疗作用及对血清PCT、IL-6的影响[J].山西中医，2012,28(7):38-39.
• [21]宋景春，林青伟，曾庆波，等.大黄素对脓毒症后期小鼠血小板功能的调节作用[J].医学研究生学报，2017,30(7):709-714.
• [22]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.