| 摘要: |
| 目的:探讨连续血液净化( CBP)联合鸟司他丁治疗重症脓毒症的疗效。方法:选择重症脓毒症患者 120例，随机分为对照组和观察组。两组均给予常规抗感染、液体复苏、穿刺引流控制感染灶，应用多巴胺、去甲肾上腺素等血管活性药物，必要时给予机械通气。同时两组在确诊脓毒症 4 h内均采用 CBP治疗。在此基础上，观察组静脉注射乌司他丁 50万 IU/d，连续应用 7 d。检测入院时和入院后第 1、3、5天取血检测血浆 C反应蛋白 (CRP)、血清乳酸( Lac)、血清降钙素原(PCT)、白细胞介素 -10(IL-10)水平。在患者入院时及入院后第 1、3、5天分别进行序贯器官衰竭评估 (SOFA)和急性生理学与慢性健康状况评分Ⅱ( APACHE II)。结果:两组患者治疗后第 1、3、5天的 CRP、Lac、PCT、IL-10均低于治疗前(均 P<0.05)；且观察组治疗后各时点的 CRP、Lac、PCT和 IL-10显著低于对照组。两组患者治疗后第 1、3、5天的 SOFA评分和 APACHElI评分均显著低于治疗前；且观察组在入院第 1、3、5天的 SOFA评分和 APACHElI评分均显著低于对照组，差异有统计学意义(均 P<0.05)。结论: CBP联合乌司他丁能够清除炎症介质、纠正机体缺血缺氧、改善组织细胞和器官低灌注，维持血流动力学稳定，减少器官的损伤，值得重症脓毒症患者早期应用。 |
| 关键词: 重症脓毒症 乌司他丁 连续性血液净化 炎症感染 |
| DOI：10.3969/j.issn.1007-6948.2020.01.008 |
| 投稿时间：2019-02-16 |
| 基金项目: |
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| Clinical Study of Continuous Blood Purification Combined with Ulinastatin in Treatment of Septic Shock |
| LI Bing,LU Hong-jun,CUI Nai-qiang |
| Traditional Chinese Medicine Hospital of Rizhao, Shandong Province, Rizhao (276800), China |
| Abstract: |
| Objective To investigate the clinical effect of continuous blood puri.cation (CBP) combined with ulinastain in the treatment of sepsis shock. Methods Totally 120 patients diagnosed as severe sepsis were randomly divided into control group and observation group. Both groups were given routine anti-infection, .uid resuscitation, puncture and drainage to control the infection focus, dopamine, norepinephrine and other vasoactive drugs, even mechanical ventilation when necessary. At the same time, both groups were treated with CBP within 4 hours when diagnosed as severe sepsis. On this basis, the observation group received intravenous ulinastatin 500000/d for 7 days. The levels of plasma C-reactive protein (CRP), serum lactic acid (Lac), procalcitonin (PCT) and interleukin-10 (IL-10) were measured at admission and on the 1st, 3rd and 5th days after admission. Sequential organ failure assessment (SOFA) and acute physiology and chronic health score II (APACHE II) were performed at admission and on the 1st, 3rd and 5th days after admission. Results CRP, Lac, PCT and IL-10 were lower in the two groups at each time point after treatment than before treatment (all P<0.05), and Lac, PCT and IL-10 in the observation group were significantly lower than those in the control group at each time point after admission. The SOFA score and APACHEII score of the two groups were significantly lower than those of the control group on the 1st, 3rd, 5th day after admission (all P<0.05), and the SOFA score and APACHEII score of the observation group on the 1st, 3rd, 5th day after admission were signi.cantly lower than those of the control group at the same time point (all P<0.05). Conclusions CBP combined with ulinastatin can remove inflammatory mediators, correct ischemia and hypoxia, improve hypoperfusion of tissues, cells and organs, maintain hemodynamic stability and reduce organ damage, which is worthy of early application in severe sepsis patients. |
| Key words: Sepsis shock ulinastatin continuous blood puri.cation in.ammatory infection |
