不同剂量乌司他丁辅助治疗感染性休克的临床观察

Clinical Observation of Ulinastatin with Different Doses in the Adjuvant Treatment of Infectious Shock

目的:研究不同剂量乌司他丁辅助治疗感染性休克(IS)的临床疗效和安全性。方法:回顾性分析78例IS患者资料,根据用药及剂量的不同均分为对照组、低剂量组、高剂量组。对照组患者给予抗菌药物、调整酸中毒、维持血管舒缩功能、补充血容量、营养支持等常规治疗。低剂量组患者在对照组治疗的基础上给予乌司他丁注射液20万单位,加入0.9%氯化钠注射液200 ml中静脉滴注,每日2次。高剂量组患者在对照组治疗的基础上给予乌司他丁注射液100万单位,加入0.9%氯化钠注射液500 ml中静脉滴注,每日2次。各组患者疗程均为7 d。观察各组患者治疗前后尿量、心率(HR)、收缩压(SBP)、肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、IL-6,临床症状恢复正常时间、住院时间,多器官功能障碍综合征(MODS)发生率、病死率及不良反应发生情况。结果:治疗后,各组患者HR、TNF-α、IL-1、IL-6均显著低于同组治疗前,且高剂量组<低剂量组<对照组;尿量、SBP均显著高于同组治疗前,且高剂量组>低剂量组>对照组,差异均有统计学意义(P<0.05)。患者临床症状恢复正常时间、住院时间、MODS发生率、病死率比较,高剂量组<低剂量组<对照组,差异均有统计学意义(P<0.05)。各组患者治疗期间均未见明显不良反应发生。结论:高剂量乌司他丁较低剂量或常规治疗可更好地抑制IS患者炎症因子释放、增加尿量、降低病死率,且安全性较好。

OBJECTIVE：To study the clinical efficacy and safety of ulinastatin with different doses in the adjuvant treatment of infectious shock（IS）.METHODS：According to the different doses,totally 78 patients with IS which were randomly divided into control group,low dose group and high dose group were retrospectively analyzed.Patients in control group were given routine treatment,including treating with antibiotics,adjusting acidosis,maintaining vasomotor function,adding volume and nutritional supporting,etc.Patients in low dose group were given ulinastatin injection 200 000 U adding into 0.9% sodium chloride injection200 ml based on the treatment of control group,iv,twice a day.Patients in high dose group were given 1 000 000 U adding into0.9% sodium chloride injection 500 ml based on the treatment of control group,iv,twice a day.The course of them was 7 d.The clinic data was observed,including urine volume,HR,SBP,TNF-α,IL-1 and IL-6 before and after treatment,recovery time of clinical symptoms,hospitalization time,the incidence and mortality of multiple organ dysfunction syndrome（MODS）and ADR.RESULTS：After treatment,the HR,TNF-α,IL-1 and IL-6 in 3 groups were significantly lower than before,and high dose group〈low dose group〈control group;urine volume and SBP were significantly higher than before,and high dose group〉low dose group〉control group,with significant differences（P〈0.05）.The recovery time of clinical symptoms,hospitalization time,MODS incidence and mortality in high dose group were lower than low dose group and control group was the highest,with significant differences（P〈0.05）.There were no obvious adverse reactions during the treatment.CONCLUSIONS：Ulinastatin with high dose is significantly better than low dose or routine treatment in inhibiting the inflammatory factor release,increasing urine volume and decreasing mortality with good safety.