乌司他丁联合磷酸肌酸钠对脓毒症心肌损伤的保护作用

Protective effects of ulinastatin combined with creatine phosphate sodium on myocardial injury in sepsis

目的探讨乌司他丁联合磷酸肌酸钠对脓毒症患者心肌损伤的保护作用。方法将60例脓毒症患者随机分为对照组、乌司他丁组和乌司他丁联合磷酸激酸钠组(联合组)三组,对照组给与抗脓毒症集束化治疗,乌司他丁组在对照组基础上加用乌司他丁,联合组在乌司他丁组基础上给予磷酸激酸钠。治疗5天后抽血测心肌钙蛋白(c Tn I)、B-型钠尿肽(BNP)、肿瘤坏死因子(TNF-a)、白介素-6(IL-6)、C-反应蛋白(CRP)、乳酸(Lac)的变化,监测急性生理和慢性健康状况评分(APACHE II)评分的变化及心功能的变化。结果乌司他丁组、联合组治疗第5天后以上检测指标与对照组比较差异有统计学意义(P<0.05),且联合组优于乌司他丁组。三组APACHEⅡ评分均低于治疗前,且联合组比对照组及乌司他丁组下降的更为明显(P<0.05)。结论乌司他丁能够保护脓毒症患者心肌并改善其心功能,联合应用磷酸激酸钠直接对损伤的心肌细胞供能取得的效果更为明显。

Objective To investigate the protective effect of Ulinastatin associated with Creatine phosphate sodium on myocardial damage of patients with severe sepsis. Methods Sixty patients with sepsis, accompanied with myocardial damage, were randomly divided into a control group, Ulinastatin group and Ulinastatin combined with Creatine phosphate sodium group（combined group）. The control group was given conventional ICU anti-sepsis cluster, Ulinastatin group plus Ulinastatin intravenously,combined group were given Creatine phosphate sodium intravenously in Ulinastatin group basisy. The blood was collected to determine cTn - I, BNP,TNF - α,IL - 6, CRP and Lac before treatment and 5 days after treatment, The APACHE 11 and heart function were observed before treatment and 5 days after treatment. Results With 5 - day treatment Control group between with Ulinastatin group and combined group, the detection of targets were significantly different（ P 〈 0. 05 ） , and the combined group was better than that of Ulinastatin group. APACHE II score was lower than those in the three groups before treatment and on the 5th day the combined group decreased more significantly than the control group and Ulinastatin group （ P 〈 0. 05 ）. Conclusions Ulinastatin can effectively protect myocardial sepsis patients and to improve the heart function, combined application of Creatine phosphate sodium directly to the injury of the myocardial cell energy supply has more significant effect.