RESUMO
Objective To observe the effect of Xuebijing injection on blood coagulation in patients with sepsis. Methods 300 patients with sepsis were randomly divided into control group and Xuebijing injection treatment group(each,150 cases). According to the guidelines of treatment for sepsis,the conventional treatment was given to both groups,and additionally Xuebijing injection 50 mL plus normal saline 100 mL intravenous drip was applied in the treatment group,twice a day for consecutive 7 days. Before treatment and after treatment for 3 days and 7 days,platelet count(PLT),four items of blood coagulation〔prothrombin time(PT),thrombin time(TT),fibrinogen (Fib)and activated partial thromboplastin time(APTT)〕,D-dimer levels and disseminated intravascular coagulation (DIC)incidence were observed in the two groups. Results Before treatment,the levels of Fib,PT,TT,APTT, PLT,D-dimer and the incidence of DIC had no significant differences between the two groups(all P>0.05);after treatment,the levels of PT,TT,APTT,D-dimer and the DIC incidence were significantly lower than those before treatment,while Fib and PLT were significantly enhanced after treatment,and on the 7th day after treatment,the changes in Xuebijing group were more obvious〔Fib(g/L):3.02±0.51 vs. 2.53±0.56,PT(s):13.82±1.91 vs. 16.03±1.68,TT(s):13.85±1.94 vs. 16.03±1.65,APTT(s):39.47±4.73 vs. 42.75±5.24,PLT(×109/L):118.10±15.80 vs. 99.77±15.67,D-dimer(mg/L):3.17±0.26 vs. 3.66±0.50,DIC incidence:5.3%(8/150)vs. 14.0%(21/150),P<0.05 or P<0.01〕. Conclusion Xuebijing injection can improve the hypercoagulable state and reduce the incidence of DIC in patients with sepsis.
RESUMO
Objective To evaluate the different methods of blood purification for acute septic renal injury (AKI) in respect of outcome by using RIFLE(risk,injury,failure,loss and end-stage renal disease)criteria and A-PACHE Ⅱ score. MethodData of 96 patients with ASRI admired to ICU of Tianhe Hospital, Tianjin, from March 2004 to September 2006 were analyzed. Including criteria: 2001 International Sepsis Definitions Conference and 2004 RIFLE criteria of AKI. The methods of blood purification used continuous renal replacement therapy (CRRT, n=54) and imermittent hemodialysis (IHD, n=42).The patients of CRRT group could be classified into stages Ⅰ, Ⅱ and Ⅲ referred to RIFLE criteria. Excel was evaluated to set up clinical data base from documented material. Data were analyzed with SPSS version 11. 5 software. Physical signs, laboratory findings, variation of APACHE Ⅱ score and outcomes of patients were documented evaluated. Data of two groups compared using indepent samples T test, before and after the treatment compared using paired-samples T test, rate compared using chi-square test. Results①There were no statistical differences in APACHE Ⅱ score and creatinine (Cr) between CRRT group and IHD group before treatment (P>0.05). The mortalities of CRRT group and IHD group were 51.9％ and 52.4％, respectively (P>0.05), but the recovery rates of renal function in CRRT group and IHD group were 92.3％ and 65.0％ ,respectively (P< 0.05).②Mean arterial pressure (MAP),oxygen saturation (SpO2) of CRRT group were lower than those of IHD group (P<0.05) and they increased to some extent after treatment (P< 0.05). ③In the patients of stag Ⅰ ,the survival rate was 78.6％, APACHE Ⅱ score was 25.4± 2.5 before treatment, renal function recovery rate was 90.9％ ,and APACHE Ⅱ changed - 13.6 ± 4.3, while those relevant markers in the patients of stage Ⅲ were 38.1％, 36.1 ± 5.7,62.5 ％ and - 7.1 ± 4.2, respectively (P<0.05). ConclusionsThe RIFLE criteria has guiding significance for the early diagnosis and prognosis of ASRI,and the RIFLE and APACHE Ⅲ score may help to choose the optimum opportunity of treatment and the early CRRT as soon as possible after diagnosis can improve the outcome of patients with acute septic renal injury.