乌司他丁治疗脓毒血症的临床疗效观察

Clinical observation on ulinastatin in treatment of sepsis

目的探讨乌司他丁治疗脓毒血症的临床效果及安全性。方法选取牡丹江医学院第二附属医院2012年1月至2013年1月收治的脓毒血症患者40例,随机分为治疗组(20例)及对照组(20例),对照组采用传统抗感染、对症支持、稳定内环境治疗,治疗组在对照组治疗基础上加用乌司他丁3×105U+5%葡萄糖100 mL,静脉滴注,0.8 h/次,3次/d,两组患者均持续治疗7 d。两组患者分别于治疗前后采用APACHEⅡ评分表对患者病情进行评分,同时观察两组患者IL-1、IL-6、IL-8、TNF-α炎症因子水平的变化、两组患者的预后及不良反应发生情况。结果治疗后两组患者APACHEⅡ评分均显著低于治疗前,且治疗组患者APACHEⅡ评分较对照组低,差异有统计学意义(P<0.05)。治疗组患者治疗后IL-1、IL-6、IL-8、TNF-α水平均显著低于对照组,差异有统计学意义(P<0.05)。治疗后治疗组患者白细胞计数、中性粒细胞计数、体温显著低于对照组,差异有统计学意义(P<0.05),而心率与对照组相比无统计学意义。对照组患者无发生不良反应,治疗组患者呕吐1例、腹泻1例,停药治疗后症状自行消失,两组不良反应发生率无统计学意义。结论乌司他丁治疗脓毒血症患者能显著改善其病情,降低相关炎症因子水平,有利于患者预后。

Objective To investigate the clinical efficiency and security of ulinastatin in treatment of sepsis.Methods The patients（40 cases） diagnosed with sepsis in Second Affiliated Hospital of Mudanjiang Medical College from January 2012 to January 2013 were randomly divided into treatment（20 cases） and control（20 cases） groups.The patients in the control group were administered with traditional anti-infection,symptomatic,and supportive,stable internal environment treatment.The patients in the treatment group were iv administered with ulinastatin 3×105U ＋ 100 mL 5% glucose,0.8 h/d,three times one day,and two groups were treated for 7 d.The clinical effects of patients were evaluated by APACHE II score before and after the treatment,while IL-1,IL-6,IL-8,TNF-α,and adverse reactions were observed.Results After the treatment,APACHE II scores of the two groups were significantly lower than those before the treatment,and the APACHE II score of the patients in the treatment group was lower than that in the control group with significant difference（P 0.05）.IL-1,IL-6,IL-8,and TNF-α levels of the treatment group were lower than those in the control group with significant difference（P 0.05） after the treatment.After the treatment,white blood cell count,neutrophil count,and body temperature of patients in the treatment group were significantly lower than those of the control group with significant difference（P 0.05）,while heart rate had no statistical significance between the two groups.Patients in the control group had no adverse reactions,patients in the treatment group had one case with vomiting and one case with diarrhea,after the treatment the discontinuation symptoms disappeared,the rate of adverse reactions between the two groups had no statistical significance.Conclusion Ulinastatin in the treatment of sepsis could significantly improve the patients＇ condition,and reduce the level of inflammatory factors,which are beneficial to the prognosis of the patients.