乌司他丁联合连续性肾脏替代治疗对老年脓毒症患者肠黏膜屏障功能的影响评价

Effect of ulinastatin combined with continuous renal replacement therapy on intestinal mucosal barrier function in elderly patients with sepsis

目的观察连续性血液净化及其与乌司他丁联合对老年脓毒症患者肠粘膜屏障功能的影响，并与乌司他丁疗效相对比，进一步为临床治疗提供依据。方法将人选的老年脓毒症患者96例随机分为乌司他丁治疗组（UTI组）（n=32）、肾脏替代治疗组（CRRT组）（n=32）和UTI＋CRRT组（n=32）。所有患者均按照指南给予基础治疗，同时UTI组及UTI＋CRRT组加用同等剂量乌司他丁，CRRT组及UTI＋CRRT组尽早行CRRT治疗。分别于入住ICU当时与入住ICU后第2、3、7天（DO、D2、D3、D7）测定血清肠脂肪酸结合蛋白（IFABP）、二胺氧化酶（DAO）、D-乳酸（D—Lac）水平变化，并记录患者APACHEII评分、ICU住院时间及28d生存情况。结果人科时，3组APACHEII评分、血浆IFABP、DAO、D—Lac水平差异均无统计学意义（P〉0．05）。经治疗后，3组血浆IFABP、DAO、D—Lac水平均有所下降，但UTI＋CRRT组下降趋势表现得更加明显；从D3观察点开始，UTI＋CRRT组血浆IFABP、DAO、D—Lac水平均明显低于UTI组及CRRT组（P〈0．05）。经治疗后，UTI＋CRRT组APACHEII评分及ICU住院时间小于另两组（P〈0．05）。两组28d病死率差异无统计学意义（P〉0．05）。结论UTI与CRRT治疗老年脓毒症患者对肠屏障功能都具有一定的保护作用，且疗效相似，但乌司他丁联合CRRT治疗对于肠粘膜屏障功能的保护作用更显著，可以更好地改善老年脓毒症患者的预后，明显减少ICU住院时间，但对降低28d病死率影响不明显。

Objective To observe the effects of continuous blood purification combined with ulinastatin （UTI） on intestinal mucosal barrier function in elderly patients with sepsis and to compare with the efficacy of UTI and to provide further evidence for clinical treatment. Methods Ninety six patients with sepsis were randomly divided into a UTI group （n = 32）, a continuous renal replacement therapy （CRRT） group （n = 32）, and a UTI ＋ CRRT group （n = 32）. All patients were given a basic therapy according to the guideline. In the UTI group and UTI ＋ CRRT group, UTI were administered in the same dose. In the CRRT group and UTI ＋ CRRT group, CRRT was performed as early as possible. The serum levels of intestinal fatty acid binding protein （IFABP）, diamine oxidase （DAO）, and D-lactic acid （D-Lac） were measured at the time of admission into ICU and day 2, 3, and 7 after admission （DO, D2, D3, DT） ）. The APACHE II score, hospitalization time in the intensive care unit （ICU）, and 28-day mortality were recorded individually. Results There were no statistical differences in APACHE II score and plasma IFABP, DAO, and D-Lac levels among the three groups （P 〉 0.05） at the admission into the ICU. After treatment, the levels of IFABP, DAO, and D-Lac in the 3 groups were lower than before, especially in the UTI ＋ CRRT group. From D3 on, the plasma levels of IFABP, DAO, and D-Lac in the UTI ＋ CRRT group were significantly lower than those in the UTI group and CRRT group （P 〈 0.05）. The APACHE II score and hospitalization time in the ICU were less in the UTI ＋ CRRT group than in the other two groups （P 〈 0.05）. There was no statistical difference in mortality among the 3 groups （P 〉 0.05）. Conclusions UTI and CRRT have similar protective effects on intestinal barrier function in elderly patients with sepsis. The UTI ＋ CRRT group has an evident protective role in improving the prognosis and decreasing hospitalization time in the ICU. However, there are no statistical differences in 28 d mortality among the 3 groups.