乌司他丁在治疗危重症患者合并凝血功能障碍的临床疗效

Therapeutic effect of ulinastatin on blood coagulation dysfunction of critical ill patients

目的观察乌司他丁治疗危重症患者合并凝血功能障碍的临床疗效。方法将2014年1月-2017年6月该院重症监护室诊治的58例合并凝血功能障碍的患者随机分为乌司他丁组和对照组,对照组常规予以病因治疗,包括血浆与血小板的替代治疗以及常规抗凝治疗;乌司他丁组在对照组基础上予以静脉滴注5%葡萄糖注射液500 ml+乌司他丁10万u。记录两组患者治疗前、治疗后第1、3、5和7天各项凝血指标[包括:血小板计数(PLT)、D-二聚体(D-D)、纤维蛋白原(FIB)、凝血酶原时间(PT)和活化部分凝血活酶时间(APTT)];对比两组患者临床疗效情况、治疗期间并发症发生情况以及死亡情况。结果治疗后,两组患者各项凝血指标均有所改善,其中乌司他丁组患者在治疗7 d后各项凝血指标均恢复正常,且同一时期指标恢复水平显著优于对照组(P<0.05);两组患者治疗总有效率、并发症发生率和死亡率比较差异均有统计学意义(P<0.05)。结论乌司他丁可通过抑制炎症反应,保护血管内皮细胞,保护凝血系统,改善危重症患者的凝血功能,大大降低了危重症患者并发症及不良事件的发生率,应在临床中进行推广使用。

【Objective】To observe the therapeutic effect of ulinastatin on blood coagulation dysfunction of critical ill patients.【Methods】From January 2014 to June 2017, 58 critical ill patients with blood coagulation dysfunction in Intensive Care Unit（ICU） were randomly divided into ulinastatin group and control group, with 29 cases in each group. Control group received routine treatment, such as pathogenesis treatment, infusion with plasma and platelet and anticoagulant therapy; ulinastatin group was additionally given ulinastatin injection on the basis of control group, 5% glucose injection with ulinastatin 100000 u intravenously, 3 times/d, for consecutive 1 week. Coagulation indexes, like the platelet count（PLT）, D-dimer（D-D）, fibrinogen（FIB）, prothrombin time（PT）, activated partial thromboplastin time（APTT） were detected before treatment and on the first, third, fifth and seventh day after treatment. The curative effect, morbidity of complications during the treatment and mortality were compared after treatment. 【Results】After treatment, coagulation indexes of both two groups get better, while the coagulation indexes in ulinastatin group recovered to normal level after 1 week of treatment, which were significantly better than that in control group, with statistical significance（P〈0.05）. There was a statistically significant difference in the curative effect, morbidity of complications during the treatment and mortality between the two groups（P〈0.05）.【Conclusion】Ulinastatin can protect the blood coagulation system, improve the coagulation function of critical patients, greatly reduce the morbidity of complications and adverse event, and it should be widely promoted in clinic.