摘要目的 观察血必净注射液对脓毒症血管内皮细胞(VEC)损伤?微循环障碍?器官功能障碍的临床效果.方法 2016年3月至2017年3月我院收治的73例严重脓毒症患者随机分为血必净注射液治疗组(40例)和对照组(33例).两组均给予常规西医综合治疗,治疗组在综合治疗基础上加用血必净注射液100 ml+生理盐水100 ml静脉滴注,每12小时1次,连用5 d.观察治疗前后两组患者的血管内皮损伤指标可溶性血栓调节素(sTM)、血管内皮生长因子2(VEGF?2)、内皮特异性分子1(ESM?1),微循环障碍指标动脉血乳酸(Lac)、中心静脉血氧饱和度(ScvO2)、舌下微血管的总血管密度(TVD)、灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI).记录治疗前后序贯器官衰竭评分(SOFA).结果 73例脓毒症患者治疗前均有不同程度的血管内皮损伤指标、动脉血乳酸及序贯器官衰竭评分升高,中心静脉血氧饱和度、舌下微血管的总血管密度、灌注血管密度、灌注血管比例、微血管流动指数下降,治疗5d后两组患者上述指标均获不同程度改善.中药血必净注射液治疗组治疗后血管内皮损伤指标sTM[(16.91±4.55)μg/L与(19.51±4.09)μg/L,t=-6.021,P<0.05]、VEGF?2[50.8(17.8,127.7)ng/L与74.9(22.7,155.1)ng/L,t=4.227,P<0.05]、ESM?1[(10.20±2.43)μg/L与(14.80±3.52)μg/L,t=-4.113,P<0.05],Lac[(2.1±0.7)mmol/L与(3.7±1.1)mmol/L,t=2.366,P<0.05]和SOFA[(5.9±2.1)分与(8.7±2.6)分,t=-7.900,P<0.05]较对照组同期下降明显,治疗后治疗组ScvO2[(0.771±0.153)%与(0.641±0.113)%,t=5.061,P<0.05],PVD[(16.8±6.1)mm/mm2与(12.1±5.1)mm/mm2,t=4.002,P<0.05],PPV[(66.2±21.3)%与(50.4±19.3)%,t=-2.550,P<0.05],MFI[(6.2±2.4)与(3.8±2.2),t=-5.001,P<0.05]较对照组同期升高明显.sTM与PPV为显著负相关(r=-0.755,P=0.000),ESM?1与PVD、PPV、MFI均呈显著负相关(r=-0.665,P=0.000;r=-0.600,P=0.000;r=-0.469,P=0.000),PPV、MFI与SOFA均呈显著负相关(r=-0.798,P=0.000;r=-0.995,P=0.000);sTM、ESM?1与SOFA均呈显著正相关(r=0.883,P=0.000;r=0.881,P=0.000).结论 血管内皮细胞功能损害在脓毒症的病理生理中可能具有重要作用,中药血必净注射液可通过保护血管内皮细胞功能对脓毒症有一定治疗作用.

abstractsObjective To observe the clinical therapeutic effect of Xuebijing injection on vascular endothelial cell ( VEC) injury,microcirculation disorder and organ dysfunction in patients with sepsis. Methods Seventy?three patients with sepsis were randomly divided into two groups:Xuebijing injection?treated group (40 cases) and control group (33 cases). Routine medicine therapy was applied in both groups. Additionally, the Xuebijing injection?treated group was treated with Xuebijing injection 100 ml and saline 100 ml by intravenous drip every 12 hours for consecutive 5 days. Vascular endothelial injury index, including soluble thrombomodulin( sTM) ,vascular endothelial growth factor 2 ( VEGF?2) ,endothelial specific molecule 1 ( ESM?1),microcirculation index of arterial blood lactic acid (Lac),central venous oxygen saturation (ScvO2),total microvessel density (TVD),the perfusion vascular density (PVD),proportion of perfused vessels (PPV) and microvessel flow index ( MFI) of the two groups before and after therapy were observed and the sequential organ failure score ( SOFA) was recorded before and after treatment. Results Senventy?three patients with sepsis had different degrees of increase in vascular endothelial damage markers,lactate and sequential organ failure scores in arterial blood, while the central venous blood oxygen saturation ( ScvO2 ) , the total vascular density of the sublingual microvasculature ( TVD) ,perfused vessel density ( PVD) ,proportion of perfused vessels ( PPV) and microcirculatory flow index ( MFI) decreased before treatment. After 5?day treatment,the above indicators of all patients were improved,the indexes in the Xuebijing injection group decreased significantly,compared with the control group ,sTM ( (16. 91±4. 55) μg/L,(19. 51±4. 09) μg/L,t=-6. 021,P<0. 05),VEGF?2 (50. 8 (17. 8,127. 7) ng/L vs. 74. 9(22. 7,155. 1) ng/L,t=4. 227,P<0. 05),ESM?1 ( (10. 20 ±2. 43) μg/L vs. (14. 80±3. 52) μg/L,t=-4. 113,P<0. 05),Lac( (2. 1±0. 7) mmol/L vs. (3. 7±1. 1) mmol/L,t=2. 366,P<0. 05) and SOFA ( (5. 9±2. 1) vs. (8. 7±2. 6),t=-7. 990,P<0. 05). ScvO2( (0. 771±0. 153) % vs. (0. 641±0. 113) %,t=5. 061,P<0. 05),PVD ( (16. 8±6. 1) mm/mm2 vs. (12. 1±5. 1) mm/mm2,t=4. 002, P<0. 05),PPV ( (66. 2±21. 3) % vs. (50. 4±19. 3) %,t=-2. 550,P<0. 05) and MFI (6. 2 ±2. 4) vs. (3. 8 ±2. 2),t=-5. 001,P<0. 05) were significantly higher than those in the control group in the same period. sTM and PPV had a significant negative correlation (r=-0. 755,P=0. 000),PVD,PPV,ESM?1 and MFI were negatively correlated (r=-0. 665,P=0. 000; r=-0. 600,P=0. 000; r=-0. 469,P=0. 000),PPV,MFI and SOFA were negatively correlated ( r=-0. 798,P=0. 000;r=-0. 995,P=0. 000);sTM,ESM?1 and SOFA were significantly positively correlated ( r = 0. 883, P = 0. 000;r = 0. 881, P = 0. 000 ) . Conclusion Vascular endothelial cell dysfunction probably plays an important role in the pathophysiology of sepsis and Xuebijing injection has therapeutic effect on sepsis by protecting vascular endothelial cell function.