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。
Objective To investigate the clinical effect of continuous blood purification(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,fluid 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 significantly 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.
作者
厉兵
卢洪军
崔乃强
LI Bing;LU Hong-jun;CUI Nai-qiang(Traditional Chinese Medicine Hospital of Rizhao,Shandong Province,Rizhao 276800,China;不详)
出处
《中国中西医结合外科杂志》
CAS
2020年第1期42-46,共5页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
关键词
重症脓毒症
乌司他丁
连续性血液净化
炎症感染
Sepsis shock
ulinastatin
continuous blood purification
inflammatory infection
