乌司他丁对严重脓毒症患者远期预后及体内降钙素原的影响

Effect of ulinastatin on serum procalcitonin level and long-term prognosis of severe sepsis patients

目的观察乌司他丁(UTI)对严重脓毒症患者60 d预后及体内降钙素原(PCT)的影响。方法收集符合标准的患者151例,根据患者60 d预后情况分为生存组(n=84)和死亡组(n=67);再根据患者是否予UTI治疗分为UTI组(n=69)和非UTI组(n=82)。患者的性别、年龄、预后、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、乳酸、白细胞(WBC)、淋巴细胞(LY)、血小板(PLT)、PCT等指标被收集。结果确诊脓毒症第1天死亡组年龄、APACHEⅡ评分、乳酸、PCT均显著高于生存组,LY、UTI治疗例数显著低于生存组,差异均有统计学意义(P<0.05),UTI治疗是患者60 d死亡保护因素(RR=0.504,P=0.008);UTI组与非UTI组患者的一般指标比较,差异均无统计学意义,第6天与第1天各指标动态变化值两组比较,APACHEⅡ评分、乳酸、WBC、LY、PLT差异均无统计学意义,PCT变化值两组比较,UTI组降低更明显,差异有统计学意义(P<0.05)。UTI组患者60 d生存率及生存时间均显著高于非UTI组(P<0.05)。结论 UTI是严重脓毒症患者60 d死亡保护因素,常规治疗联合UTI能够显著提高严重脓毒症患者60 d生存率、延长患者生存时间,显著降低患者体内感染指标PCT。

Objective To determine the effect of ulinastatin （UTI） on serum procalcitonin（PCT） level and 60 - day prognosis in severe sepsis patients. Methods 151 severe sepsis patients were included in this study. All the patients （n = 151 ） were divided into survival group （n = 84） and non- survival group （n =67）, and all the pa- tients （n = 151 ） were also divided into UTI group （n =69） and non -UTI group （n =82）. Gender, age, progno- sis, acute physiology and chronic health evaluation 11 （APACHE Ⅱ ） score, lactate, leucocyte, lymphocyte, platelet and PCT were retrospectively collected. Results Compared with survival group, non - survival group was significantly higher in age, APACHE Ⅱ score, lactate, PCT, and significantly lower in lymphocyte and the number of UTI treatment （P 〈 0. 05）. Treatment with UTI was found to produce a significant decrease in death risk （RR = 0. 504, P =0. 008）. UTI group and non-UTI group were similar in age, sex, APACHE [[ score, lactate, leuco- cyte, lymphocyte, platelet and PCT. Dynamic changes on Day 6 and Day 1 （the day when patients were diagnosed with severe sepsis） in APACHE II score, lactate, leucocyte, lymphocyte, platelet were not significantly different in UTI group and non-UTI group. Decrease in PCT was more significant in UTI group than in non-UTI group （P 〈 0.05 ）. Survival rate at 60 days was significantly higher in UTI group than in non-UTI group （ P 〈 0. 05 ）. Moreo- ver, the survival analysis curves showed that patients in UTI group survived longer than patients in non-UTI group （P 〈 0. 05）. Conclusion The present study indicates that treatment with UTI can significantly reduce death risk in severe sepsis patients. Conventional therapy combined with UTI can significantly improve 60-day prognosis and reduce serum PCT level in severe sepsis oatients.