乌司他丁对MODS患者CVVH后炎症因子的影响

The Effects of Ulinastatin on Inflammatory Mediators in Patients with Multiple Organ Dysfunction Syndrome after Continuous Veno-venous Hemofiltration

目的观察乌司他丁(UT)对多脏器功能不全综合症(MODS)患者日间连续性血液滤过(CVVH)后炎症因子的影响。方法39例MODS患者随机分为治疗组(20例)和对照组(19例),除常规治疗外,治疗组于CVVH结束时予UT治疗,对照组予等量生理盐水治疗,观察两组的临床症状、APACHEⅡ评分,检测血清C反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)的变化。结果CVVH治疗可使APACHEⅡ评分、CRP、IL-6和TNF-α显著下降(P<0.001),停止CVVH后上述指标显著升高(P<0.05);于CVVH结束时应用UT可抑制上述指标上升。结论CVVH能很好地清除MODS的炎症因子,UT可抑制CVVH后炎症因子升高,两者联用可发挥协同作用。

Objective To investigate the effects of ulinastatin（UT） on plasma level of inflammatory mediators in patients with multiple organ dysfunction syndrome（MODS） after daytime continuous veno-venous hemofiltration （CVVH）. Methods Thirty-nine patients with MODS were randomly divided into group Ⅰ （n=20） and group Ⅱ （n=19）. Both groups were given routine treatment and daytime CVVH （12 h for once time, continued for 5 days）, while the patients of group I were given UT 1000ku at the end of CVVH. The clinic symptoms acute physiology and chronic health evaluation （APACHE Ⅱ ） were observed and serum levels of C-reactive protein （CRP）,interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）were measured. Results CVVH can improve APACHE Ⅱ counts, reduce the serum levels of CRP, IL-6 and TNF-α significantly in both groups（P〈0. 001）,but they rebounded significatly after CVVH stopped in group Ⅱ （P〈 0.05）. UT,injected at the end of CVVH in group Ⅰ , can inhibit these rising. Conclusion CVVH could remove inflammatory mediators in patiens with MODS and UT could inhibit their rising when CVVH is topped,so they can cooperate in treatment.