大剂量乌司他丁治疗感染性休克临床疗效探析

The Efficacy of High-dose Ulinastatin in Treatment of Septic Shock

目的:探讨大剂量乌司他丁(Ulinastatin)对感染性休克患者的临床疗效。方法:50例感染性休克患者被随机分为常规剂量乌司他丁对照组25例和大剂量乌司他丁治疗组25例。常规对照组20万U/次乌司他丁静脉推注,2次/d;大剂量治疗组每次100万U静脉推注,1次/h,5次/d,共500万U静脉推注,次日开始进行常规治疗,20万U/次,2次/d。观测两组治疗5d后APACHEII评分、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转氨酶(AST)及血乳酸(Lac)的变化情况;两组患者用药后1h、4h、12h、1d及3d的尿量、心率(HR)、收缩压(SP);记录患者休克恢复时间、病情稳定所需时间及住ICU天数等。结果:①两组治疗5d后,大剂量治疗组APACHEII评分、ALT、AST、Lac各指标值均低于常规对照组。②大剂量治疗组用药后1h、4h、12h、1d、3d的尿量的检测值均高于常规对照组;大剂量治疗组用药后1h、4h、12h、1d、3d的HR检测值均低于常规对照组;大剂量治疗组用药后1h、4h、12h、1d、3d的SP检测值均低于常规对照组。③大剂量组休克恢复时间明显短于常规对照组;大剂量组住ICU天数明显少于常规对照组。④病死率:常规组死亡17人,病死率68%,大剂量组死亡9人,病死率36%。结论:大剂量乌司他可缩短休克恢复时间及病情稳定所需时间;降低患者病死率,促进感染性休克患者的病情的控制,改善预后。

Objective： To explore clinical efficacy of high doses ulinastatin on patients with septic shock.Method： 50 patients with septic shock were randomly divided into conventional doses ulinastatin group （conventional-dose group, 25 cases） and high doses ulinastatin group （high doses group, 25 cases）. Conventional-dose group were intravenously injected 200, 000 U of ulinastatin every time , twice a day. While the high doses group were cured one million U for half an hour by rapid intravenous injection , 5 mil-lion unit ulinastatin within 5 hours.Routine treatment were carried out the next day , 200 000 unit each time, twice a day.APACHEII ratings score, serum ALT, AST and lactic acid content were measured after treat-ment.The urine output , heart rate and systolic blood pressure of 1h, 4h, 12h, 1d and 3d in two groups were measured after treatment .Recorded the time of shock recovery , the hospitalization days and the time return to a stable condition .Result：①After treatment for 5 days, the APACHEII score , ALT, AST, Lac each index values in high-dose treatment group were lower than those of conventional control group;②The urine output detection value of 1h, 4h, 12h, one day, 3 days in high-dose treatment group were all higher than those of the normal control group after dosing; The heart rate detection value of 1h, 4h, 12h, one day, 3 days in high-dose treatment group were all lower than those of the normal control group by using drugs ;The systolic blood pressure detection value of 1h, 4h, 12h, one day, 3 days in high-dose treatment group were all higher than those of the normal control group after medication .③The shock recovery time of high-dose treatment group was significantly shorter than normal control one; The hospitalization days in intensive care unit was obviously less than normal control one .④The mortality：17 cases died in the conventional group , the fatality rate was 68 percent;nine cases died in the high-dose treatment group , the fatality rate was 36 percent .Con-clusion：High doses ulinastatin has resistance to shock , can shorten the time of shock recovery , the hospital-ization days and the time return to a stable condition .It can reduce mortality and complications , can alleviate the condition of patients with septic shock , improve prognosis .