乌司他丁联合小剂量糖皮质激素治疗脓毒症的疗效及安全性评价

Evaluation of therapeutic effect and safety of ulinastatin combined with small dose of glucocorticoid in the treatment of sepsis

目的探讨乌司他丁联合小剂量糖皮质激素治疗脓毒症的疗效及安全性。方法选取我院2015年7月至2016年6月收治的脓毒血症患者110例,采用随机分组法将其分为研究组和对照组,对照组采用常规治疗,观察组在对照组的基础上加用乌司他丁联合小剂量糖皮质激素。结果与对照组相比,观察组临床总有效率明显升高(P<0.05)。与对照组相比,观察组的机械通气时间、ICU住院时间均明显缩短且差异具有统计学意义(P<0.01)。治疗前,2组患者的急性生理与慢性健康状况评分(APACHE)Ⅱ评分、降钙素原(PCT)及C反应蛋白(CRP)水平差异无统计学意义(P>0.05)。治疗后,2组患者的APACHEⅡ评分、PCT及CRP水平与治疗前相比均明显降低,但研究组较对照组更低,2组比较差异均具有统计学意义(P<0.01)。与对照组相比,观察组患者28d内生存率明显升高且差异具有统计学意义(χ~2=4.614,P<0.01)。2组患者在治疗期间内均未出现明显不良反应。结论乌司他丁联合小剂量糖皮质激素治疗脓毒症效果显著,可降低血清PCT、CRP水平及APACHEⅡ评分,缩短患者机械通气时间、重症监护病房(ICU)住院时间,降低病死率,安全性较高,具有较高临床应用价值。

Objective To evaluate the therapeutic effect and safety of ulinastatin combined with small dose of glucocorticoid in the treatment of sepsis. Methods One hundred and ten cases of patients with sepsis in our hos- pital from July 2015 to July 2016 were selected. According to the random number table, 110 patients were divided into observation group and control group. The control group received routine treatment, and the observation group was treated with ulinastatin combined with small dose of glucocorticoid on the basis of the control group. Results The total clinical effective rate of the observation group was significantly higher than that of the control group（P〈 0. 05）. Compared with the control group, the mechanical ventilation time, ICU length of stay in the observation group were significantly shorter and the difference was statistically significant （ P〈0. 01）. Before treatment, the APACHE Ⅱ score, PCT and CRP levels of two groups of patients were not significantly different （ P〉0.05）. After treatment, the APACHE Ⅱ score, PCT and CRP levels of the two groups of patients were significantly lower than before treatment, but the observation group was lower than the control group, the difference between the two groups was statistically significant （ P 〈0.01）. Compared with the control group, the 28 day survival rate of observation group patients was increased significantly and the difference was statistically significant （ X^2= 4. 614,P〈0. 01）. The two groups of patients in the treatment period were not of significant adverse reac- tions. Conclusion The method using ulinastatin combined with small dose of glucocorticoid on the basis of the control group has better effect, which can decrease serum PCT,CRP level and APACHE Ⅱ score, shorten mechanical ventilation time and ICU hospitalization time of the patients, and reduce the mortality rate. It has high safety and high clinical application value.