标题：血必净注射液在脓毒症继发胰腺功能损伤患者中的临床应用

      作者：张志坚 1,2，田黎 2，李倩 2，彭礼波 1，董瑶瑶 1    (重庆市巴南区人民医院重症医学科 1、感染科 2，重庆 401320)

      卷次： 2018年29卷23期

      【摘要】 目的 探讨血必净注射液在治疗脓毒症继发胰腺损伤中的临床应用效果。方法 选择2015年1月至 2017年1月入住重庆市巴南区人民医院重症医学科及感染科诊断为脓毒症继发胰腺损伤的患者70例，按随机数表法分为常规治疗组和血必净注射液治疗组，每组35例。常规治疗组按照2012年严重脓毒症和脓毒性休克治疗指南进行标准治疗，包括抗感染、液体复苏、血管活性药物等及其他对症治疗；血必净注射液治疗组在标准治疗基础上予以血必净注射液100 mL，1次/d，连续使用7 d。分别于治疗前和治疗后3 d和7 d观察并记录两组患者的血尿淀粉酶、肠内营养热卡数、治疗终点的实际病死率及 ICU住院时间。结果 两组患者治疗后的血清淀粉酶(SAM)均较治疗前降低，肠内营养热卡/体质量比值较治疗前升高，且血必净注射液治疗组7 d后反映器官功能损伤各项指标的变化较常规治疗组改善更明显[SAM：(59.9±11.2) U/L vs (97.1±12.3) U/L；肠内营养热卡/体质量比值：(89.12±13.22) kJ/kg vs (59.98±15.65) kJ/kg]，差异均有统计学意义(P<0.05)；血必净注射液治疗组与常规治疗组的实际病死率/预期病死率[(0.30±0.05) vs (0.48±0.04)]、重症医学科住院时间[(10.3±3.9) d vs (7.1±4.1) d]比较差异均有统计学意义(P<0.05)。结论 血必净注射液能显著改善脓毒症相关胰腺损伤患者的胰腺功能，提高肠内营养耐受性，降低患者的病死率和重症医学科住院时间。
      【关键词】 血必净注射液；脓毒症；胰腺功能损伤；肠内营养；病死率
      【中图分类号】 R631 【文献标识码】 A 【文章编号】 1003—6350（2018）23—3318—03

Clinical research of Xuebijing injection in patients with secondary pancreatic function injury induced by sepsis.ZHANG Zhi-jian 1,2, TIAN Li 2, LI Qian 2, PENG Li-bo 1, DONG Yao-yao 1.
Department of Critical Care Medicine 1,Department of Infectious Disease 2, Ba'nan People's Hospital of Chongqing, Chongqing 401320, CHINA
【Abstract】 Objective To study the clinical application of Xuebijing injection in the treatment of secondarypancreatic function injury induced by sepsis. Methods A total of 70 patients with secondary pancreatic function injuryinduced by sepsis who were admitted in the Department of Critical Care Medicine and diagnosed by the Department ofInfectious Disease, Ba'nan People's Hospital of Chongqing, from January 2015 to January 2017 were randomly dividedinto a conventional treatment group (35 cases) and a Xuebijing injection treatment group (35 cases) according to the ran-dom number table method. The conventional treatment group was treated according to the severe sepsis and septic shocktreatment guidelines in 2012, including anti-infection, fluid resuscitation, vascular active drugs, and other symptomatictreatments. On the basis of standard treatment, the patients in Xuebijing injection treatment group were additionally giv-en of Xuebijing injection 100 mL, once daily for 7 days. The serum amylase (SAM), the calorie of enteral nutrition, actu-al mortality rate at the treatment endpoint, and ICU hospitalization time of the two groups were observed and recordedbefore and 3 and 7 days after treatment, respectively. Results After treatment, the SAM levels of the two groups wereboth lower than those before treatment, and the ratios of enteral nutrition calorie /body weight were higher than thosebefore treatment; and after 7 days of treatment, the changes of various indexes reflecting organ functional injury inXuebijing injection treatment group were more significant than those in the conventional treatment group, includingSAM (59.9 ± 11.2) U/L vs (97.1 ± 12.3) U/L, ratio of enteral nutrition of calorie/body weight (89.12 ± 13.22) kJ/kg vs(59.98±15.65) kJ/kg, and all differences were statistically significant (P<0.05). The actual mortality/expected mortalityrate (0.30±0.05) vs (0.48±0.04), and the length of hospital stay in ICU (10.3±3.9) d vs (7.1±4.1) d between the Xuebijinginjection treatment group and the conventional treatment group were compared, and the differences were all statisticallysignificant (P<0.05). Conclusion Xuebijing injection treatment can significantly improve the pancreatic function in pa-tients with sepsis-related pancreatic injury, improve enteral nutrition tolerance, reduce the mortality and hospital stay inICU of the patients.
      【Key words】 Xuebijing injection; Sepsis; Pancreatic function injury; Enteral nutrition; Mortality·论 著·doi:10.3969/j.issn.1003-6350.2018.23.020基金项目：重庆市卫生和计划生育委员会科研项目(编号：2017ZBXM023)；重庆市卫生计生委中医药科技项目(编号：ZY201703036、ZY201703037)；重庆市巴南区社会事业科技计划项目(编号：2016-6)