乌司他丁对创伤性休克患者肝脏和凝血功能影响的回顾性研究

An retrospective study of ulinastatin on liver function and blood coagulation in patients with traumatic shock

目的探讨不同程度创伤性休克患者肝功能、凝血功能的变化及乌司他丁（ulinastatin，UTI）的治疗作用。方法收集2013年1月．2015年3月唐都医院ICU收治的128名创伤性休克患者病历资料，根据患者损伤严重度评分及住院期间是否应用UTI治疗，分为6组：轻度、中度、重度休克UTI治疗组及轻度、中度、重度休克常规抗休克治疗组。统计分析患者入院时的急性生理学及慢性健康状况评分系统（acute physiology and chionic health evaluation scoring system，APACHEⅡ）评分、总住院时间、ICU住院时间、病死率以及两组患者治疗前后各时间点血AST、ALT、血小板（blood platelet，PLT）、凝血酶原时间（prothrombin time，PT）、活化部分凝血活酶时间（activated partal thromboplastin time，APTT）、血浆纤维蛋白原（plasma fibfinogen，Fib）、纤维蛋白（原）降解产物[fibrin（agen）degradation products，FDP]、D-二聚体（D-dimer，D-D）的值，分析UTI对不同程度创伤性休克患者的救治效果。结果①轻度、中度创伤性休克组，UTI治疗后患者总住院时间分别为（11．0±3．0）、（14．0±4．0）d，较常规治疗组分别降低26．7％、30％；ICU住院时间（6．2±1．8）、（9．5±2．0）d，较常规治疗组分别降低42．1％、33．6％（P〈0．05）。②轻度、中度、重度创伤性休克组，UTI治疗7d后患者AST值分别为（46±19）、（68±63）、（258±133）U／L，较常规治疗组分别降低21．1％、29．4％、32．1％；ALT值为（58±16）、（68±25）、（199±53）U／L，分别降低13．9％、41．3％、41．3％（P〈0．05）；③轻度、中度创份性休克组，UTI治疗7d后患者FDP（20．6±3．2）、（32．0±8．5）mg／L、较常规治疗组分别降低42．0％、34．0％；D-D为（2．2±0．5）、（4．0±0．9）mg／L。分别降低35．76％、24．5％；PT为（10．5±1．2）、（11．2±1．2）s，分别降低7．1％、11．4％；AHTT为（26．5±2．8）、（34．2±3．1）s，分别降低15．6％、9．6％；Fib为（4．3±0．4）、（4．1±0．4）g／L，分别升高19．3％、22．1％；PLT为（200±24）×10^9／L、（186±28）×10^9／L，分别升高9．6％、40．0％（P〈0．05）。结论创伤性休克患者肝功能、凝血功能存在异常，UTI可改善轻中度患者肝功能、凝血功能，缩短总住院时间、ICU住院时间，对改善预后具有积极意义；对重度患者无明显治疗作用。

Objective To investigate the change of liver function and blood coagulation in patients with traumatic shock and the therapeutic effect of ulinastatin （UTI）. Methods Collect 128 patients＇ datawho were diagnosed with traumatic shock and admitted in ICU in Tangdu hospital from January 2013 to March 2015, according to the injury severity score and whether application of UTI treatment, they were divided into six groups： mild, moderate and severe shock of UTI treatment group, mild, moderate and severe shock of routine antishock treatment group. Related laboratory parameters were collected to evaluate the effect of UTI on patients, including acute physiology and chionic health evaluation scoring system （APACHE Ⅱ ） score upon patients＇admission, total length of stay in hospital and ICU, mortality, levels of AST, ALT, blood platelet （PLT）, prothrombin time （PT）, activated partial thromboplastin time（APTT）, plasma fibrinogen（Fib）, fibrin（agen） degradation products（FDP）, D-dimer（D-D）. Results （1） In mild and moderate traumatic shock group,the total hospital staying time were（11.0±3.0）, （14.0±4.0） d in UTI treatment group, it were reduced by /26.7%, 30% respectively, compared with the routine antishock treatment group;and the ICU staying time were （6.2±1.8）, （9.5±2.0） d, it were reduced by 42.1%, 33.6% respectively（P〈 0.05）. （2） In mild,moderate and severe traumatic shock group, the AST were （46±19）, （68±63）, （258±133） U/L in the 7th days in UTI treatment group, it were reduced by 21.1%, 29.4%, 32.1% respectively, compared with the routine antishock treatment group; and the ALT were （58±16）, （68±25）, （199±53） U/L,it were reduced by 13.9%, 41.3%, 41.3%respectively（P〈0.05）. （3） In mild and moderate traumatic shock group, the FDP were （20.6±3.2）, （32.0±8.5） mg/L, in the 7th days in UTI treatment group, it were reduced by 42.0%, 34.0% respectively, compared with the routine antishock treatment group. The D-D were （2.2±0.5）, （4.0±0.9） mg/L, it were reduced by 35.76%, 24.5% respectively. The PT were （10.5±1.2）, （11.2±1.2） s, it were reduced by 7.1%, 11.4% respectively. The APTT were （26.5±2.8）, （34.2±3.1） s, it were reduced by 15.6%, 9.6% respectively. The Fib were （4. 3±0.4）, （4.1±0.4） g/L, it were increased by 19.3%, 22.1% respectively. PLT were（200±24）xlOg/L, （186±28）×10^9/L, it were increased by 9.6%, 40.0% respectively （P〈0.05）. Conclusions In patients with mild and moderate shock, UTI can improve liver function and blood coagulation function, reduce the total staying time in hospital and ICU, and improve prognosis. While in severe traumatic shock group, UTI did not show any obvious therapeutic effect.