连续血液净化联合乌司他丁治疗脓毒症休克疗效观察

Clinical study of continuous blood purification combined with ulinastatin in the treatment of septic shock and its effect on TNF-α,IL-6 and CRP

目的:观察连续血液净化(CBP)联合乌司他丁治疗脓毒症休克的疗效。方法:选择脓毒症休克患者80例,按照入院顺序分为观察组与对照组,每组40例,2组均在常规治疗基础上,采用CBP治疗,观察组加用乌司他丁,以2万IU/h静脉滴注,连续应用7 d。评估治疗前和治疗72 h后多巴胺和去甲肾上腺素用量变化,检测血乳酸(Lac)水平、氧合指数(PaO_2/FiO_2)、炎性反应指标TNF-α、IL-6和CRP水平的变化,采用急性生理与慢性健康状况评分(APACHEⅡ)和多器官功能衰竭(MODS)评分评估疾病严重程度。结果:治疗72 h后,2组多巴胺和去甲肾上腺素用量均明显减少,组间比较无显著性差异(P> 0. 05);治疗72 h后2组血Lac水平下降,PaO_2/FiO_2上升,观察组改善效果优于对照组(P <0.05);治疗后2组TNF-α、IL-6和CRP水平均明显下降,观察组效果明显优于对照组(P <0. 05);治疗72 h后,2组APACHEⅡ和MODS评分均明显降低,观察组下降幅度大于对照组(P <0. 05)。结论:CBP联合乌司他丁治疗脓毒症休克可促进血Lac清除,升高PaO_2/FiO_2,降低体内炎性反应,改善疾病状态,联合应用可有效缓解疾病严重程度。

Objective： To study the clinical effect of continuous blood purification（ CBP） combined with ulinastatin in the treatment of septic shock. Methods： 80 patients diagnosed as sepsis shock were enrolled and divided into observation group（ n = 40） and control group（ n = 40） according to the order of admission. On the basis of conventional treatment,both groups were treated with CBP,and the observation group was also treated with ulinastatin with an intravenous infusion of 20 000 IU/h for 7 consecutive days. The amount of dopamine and norepinephrine was assessed before and 72 h after treatment. The levels of serum lactate（ Lac）,PaO2/FiO2 and TNF-α,IL-6 and CRP were measured. APACHE Ⅱ and MODS scores were used to assess the severity of the disease. Results： The dosage of dopamine and norepinephrine decreased significantly after treatment for 72 h,and there was no significant difference between the two groups（ P 〉0. 05）. The level of serum Lac decreased and PaO2/FiO2 increased in the two groups after treatment for 72 h,and the effect of the observation group was better than that of the control group（ P 〈0. 05）. The levels of TNF-α,IL-6 and CRP were significantly decreased in the two groups after treatment,and the effect of the observation group was better than that of the control group（ P 〈0. 05）. After 72 h of treatment,the APACHE Ⅱ and MODS scores in the two groups were significantly decreased,more significant in the observation group than in the control group（ P 〈0. 05）. Conclusions： CBP combined with ulinastatin treatment of septic shock can promote serum Lac clearance,increase PaO2/FiO2,reduce the body＇s inflammatory response and improve disease status.