乌司他丁对创伤性凝血病患者凝血功能及炎症因子的影响

Effect of ulinastatin on coagulation function and inflammatory cytokines in patients with traumatic coagulation disease

目的探讨乌司他丁对创伤性凝血病患者凝血功能及炎症因子的影响。方法选取2015年4月至2016年4月收治的创伤性凝血病患者80例为研究对象,根据随机数字表法将其分为观察组和对照组,各40例。对照组给予常规止血、输血、纠正酸中毒、液体复苏等治疗,观察组在此基础上加用乌司他丁治疗。比较两组凝血功能、炎症因子、血制品输注量与多器官功能障碍综合征(MODS)发生率。结果治疗前,观察组各项凝血功能指标与炎症因子水平相比,差异均无统计学意义(P均>0.05);治疗后,观察组凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)分别为(11.35±3.16)s、(28.62±3.94)s、(1.58±0.62)mg/L,较对照组的(16.47±4.24)s、(35.16±3.41)s、(4.12±1.19)mg/L均明显缩短或减少,差异有统计学意义(P均<0.05)。治疗后,观察组患者纤维蛋白原(FIB)高于对照组[(4.13±0.38)g/L vs(3.05±0.52)g/L,P<0.05]。观察组白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)水平分别为(12.75±2.58)pg/ml、(8.44±1.36)pg/ml、(34.48±2.46)pg/ml),均明显低于对照组[(32.15±4.69)pg/ml、(12.74±2.67)pg/ml、(70.17±12.63)pg/ml],差异有统计学意义(P均<0.05);观察组血制品输注量红细胞[(20.17±4.75)U]、血小板[(33.15±4.16)U]以及冷沉淀水平[(20.95±2.18)U]明显少于对照组[(25.74±6.83)U、(36.64±5.05)U、(24.59±2.37)U],MODS发生率35.00%明显低于对照组的62.50%,差异有统计学意义(P<0.05)。结论乌司他丁可明显改善创伤性凝血病患者凝血功能,降低炎症因子水平,从而有效阻止病情恶化,减少器官功能损伤。

Objective To explore the effects of Ulinastatin on coagulation function and inflammatory cytokines in patients with traumatic coagulopathy. Methods Eighty patients with traumatic coagulopathy treated between April 2015 and April2016 were selected as research objects and were divided into observation group and control group according to the random number table method（n = 40,each）. The treatment of routine hemostasis,blood transfusion,correction of acidosis,fluid resuscitation,and so on was given in control group and was given plus Ulinastatin in observation group. Coagulation function,inflammatory cytokines,transfusion volume of blood products and the incidence of multiple organ dysfunction syndrome（MODS） were compared between two groups. Results Before treatment,there were no significant differences in the indexes of coagulation function and the level of inflammatory cytokines between two groups（all P〉0. 05）; after treatment,prothrombin time（PT） [（11. 35 ± 3. 16） s vs（16. 47 ± 4. 24） s],activated partial thromboplastin time（APTT）[（28. 62 ± 3. 94） s vs（35. 16 ± 3. 41） s] and D-dimer（D-D） [（1. 58 ± 0. 62） mg/L vs（4. 12 ± 1. 19） mg/L] were significantly shorter or lower in observation group than those in control group respectively; fibrinogen（FIB） in observation group was significantly higher than that in control group[（4. 13 ± 0. 38） g/L vs（3. 05 ± 0. 52） g/L,P〈0. 05]; the levels of interleukin（IL）-6[（12. 75 ± 2. 58） pg/ml vs（32. 15 ± 4. 69） pg/ml],IL-8 [（8. 44 ± 1. 36） pg/ml vs（12. 74 ± 2. 67） pg/ml]and tumor necrosis factor-alpha（TNF-α） [（34. 48 ± 2. 46） pg/ml vs（70. 17 ± 12. 63） pg/ml] in observation group were significantly lower than those in control group（all P〈0. 05）. The transfusion volume of red blood cells[（20. 17 ±4. 75） U vs 25. 74 ± 6. 83） U],platelets[（33. 15 ± 4. 16） vs 36. 64 ± 5. 05） U]and cold precipitation [（20. 95 ± 2. 18） U vs24. 59 ± 2. 37） U] in observation group was significantly lower than that in control group（P〈0. 05）. The incidence of MODS was significantly lower in observation group than that in control group（35. 00% vs 62. 50%,P〈0. 05）. Conclusion Ulinastatin can significantly improve the blood coagulation function and decrease the level of inflammatory factors in patients with traumatic coagulopathy,thus effectively prevent disease progression and reduce organ injury.