谷氨酰胺联合乌司他丁治疗ICU脓毒症患者的临床疗效及机制分析

Clinical Efficacy and Mechanism of Glutamine Combined with Ulinastatin in the Treatment of ICU Sepsis

目的观察谷氨酰胺联合乌司他丁治疗脓毒症患者的临床疗效及机制。方法选取2014年3月—2017年6月中山市博爱医院重症监护室收治的脓毒症患者78例,按随机数字表法分为对照组和观察组,每组39例。对照组给予乌司他丁40万U/次,3次/d;观察组在对照组的基础上给予谷氨酰胺0.4 g/(kg·d),均治疗1周。比较两组治疗前后APACHE II评分、血清肿瘤坏死因子-α(TNF-α)、白介素(IL)-6、IL-1β及免疫球蛋白G(IgG)、免疫球蛋白A(IgA)、免疫球蛋白M(IgM)浓度的变化,比较两组不良反应的发生情况。结果治疗前,两组患者APACHE II评分、血清TNF-α、IL-6、IL-1β及IgG、IgA、IgM浓度间无显著性差异。治疗后,观察组APACHE II评分为(14.2±3.7)分,显著低于对照组的(16.3±4.4)分,差异有统计学意义(P<0.05)。两组患者血清TNF-α、IL-6、IL-1β浓度均显著降低,同组治疗前后比较差异有统计学意义(P<0.05),且观察组以上指标明显低于对照组,差异有统计学意义(P<0.05)。两组患者血清IgG、IgA、IgM浓度均显著升高,同组治疗前后比较差异有统计学意义(P<0.05),且观察组以上指标显著高于对照组,差异有统计学意义(P<0.05)。治疗期间,观察组不良反应发生率(2.56%)与对照组(5.13%)无差异。结论谷氨酰胺联合乌司他丁治疗脓毒症疗效好,能抑制炎症反应并促进患者免疫功能的恢复,值得临床应用于推广。

Objective To explore the clinical efficacy and mechanism of glutamine combined with ulinastatin in the treatment of ICU sepsis. Methods Selected 78 patients who with sepsis in our hospital intensive care unit from March 2014 to June 2017. All patients were divided into control group and observation group by random number table method, each group of 39 cases. The control group was treated with ulinastatin, the observation group was treated with glutamine based on the control group. APACHE II scores, serum TNF-α, IL-6, IL-1β and IgG, IgA and IgM levels were compared between the two groups before and after treatment. The incidence of adverse reactions was compared between the two groups. Results There was no significant difference in APACHE II score, serum TNF-α, IL-6, IL-1β and IgG, IgA and IgM levels between the two groups before treatment. The APACHE II score（14.2 ± 3.7） in the observation group was significantly lower than that in the control group（16.3 ± 4.4）（P 〈 0.05） after treatment. The levels of serum TNF-α, IL-6 and IL-1β were significantly decreased in both groups after treatment, and observation groups was significantly lower than that in the control group（P 〈 0.05）. The levels of serum IgG, IgA and IgM were significantly increased in both groups after treatment, and observation groups was significantly higher than that in the control group（P 〈 0.05）. The incidence of adverse reactions in the observation group（28.21%） was significantly lower than that in the control group（61.54%）（P 〈 0.05）. Conclusions Glutamine combined with ulinastatin in the treatment of sepsis is effective, can inhibit the inflammatory response and promote the recovery of immune function in patients, worthy of clinical application in the promotion.