CRRT联合乌司他丁对严重脓毒血症患者APACHE Ⅱ、SOFA和Marshall评分及炎性因子的影响

Effects of CRRT combined with ulinastatin on APACHE Ⅱ,SOFA and Marshall scores and inflammatory factors in patients with severe sepsis

目的评价连续性肾脏替代疗法(CRRT)联合乌司他丁对严重脓毒血症患者3种危重评分及其相关血清炎性因子水平变化的影响。方法选择2015年1月—2017年9月新疆医科大学第一附属医院感染科收治的严重脓毒血症患者80例作为研究对象,采用随机数字表法分为对照组(40例)和观察组(40例),在给予抗感染、液体复苏、纠正酸中毒、营养支持、机械通气和应用血管活性药物等基础上,对照组采用CRRT治疗,观察组采用CRRT联合乌司他丁治疗,治疗7 d后比较2组患者3种危重评分、相关治疗应用时间和治疗前后患者血清炎性因子的水平变化以及28 d全因死亡率。结果与治疗前相比,2组患者治疗7 d后的3种危重评分均显著降低,差异有统计学意义(P均=0. 000),且观察组降低程度更明显(t=3. 072、3. 167、3. 601,P=0. 003、0. 002、0. 001);观察组应用血管活性药物、机械通气和抗生素的时间以及ICU留治时间均显著低于对照组(t=3. 269、2. 649、3. 151、2. 933,P=0. 002、0. 010、0. 002、0. 004);与治疗前相比,治疗7 d后2组TNF-α、IL-6和IL-8水平明显降低,IL-10水平明显升高,差异均有统计学意义(P均=0. 000),且观察组改善较对照组更为明显(t=4. 356、7. 142、5. 185、-2. 641,P=0. 000、0. 000、0. 000、0. 010);对照组和观察组28 d全因死亡率分别为25. 0%和10. 0%,差异无统计学意义(χ~2=3. 117,P=0. 077); Log rank检验显示,观察组患者的死亡风险显著低于对照组(HR=0. 347,95%CI 0. 121~0. 981,P=0. 047)。结论在严重脓毒血症患者中应用CRRT联合乌司他丁能够显著改善症状评分,减少血管活性药物、抗生素、机械通气使用和ICU留治时间,降低患者28 d死亡风险。

Objective To evaluate the effects of continuous renal replacement therapy(CRRT)combined with ulinastatin on three critical scores and serum inflammatory factors in patients with severe sepsis.Methods From January 2015 to September 2017,80 patients with severe sepsis admitted to the Department of Infection in the First Affiliated Hospital of Xinjiang Medical University were selected as the study subjects.The control group(40 cases)and the observation group(40 cases)were randomly divided into two groups.Anti-infection,fluid resuscitation,correction of acidosis,nutritional support,mechanical ventilation and coping were given.On the basis of vasoactive drugs,the control group was treated with CRRT,and the observation group was treated with CRRT combined with ulinastatin.After 7 days of treatment,the changes of three critical scores,related treatment time,serum inflammatory factors and 28-day all-cause mortality were compared between the two groups.Results Compared with before treatment,the three critical scores of the two groups were significantly lower after 7 days of treatment(P=0.000),and the degree of reduction in the observation group was more obvious(t=3.072,t=3.167,t=3.601,P=0.003,P=0.002,P=0.001);the time of using vasoactive drugs,mechanical ventilation and antibiotics in the observation group and the ICU retention treatment The time of treatment was significantly lower than that of the control group(t=3.269,t=2.649,t=3.151,t=2.933,P=0.002,P=0.010,P=0.002,P=0.004),and the levels of TNF-α,IL-6 and IL-8 were significantly lower and IL-10 were significantly higher in the two groups after 7 days of treatment(P=0.000),and the improvement in the observation group was more obvious than that in the control group(t=4.356,t=7.142,t=5.185,t=-2.641,P=0.000,P=0.000,P=0.000,P=0.010);28-day all-cause mortality in the control group and the observation group were 25.0%and 10.0%,respectively,with no significant difference(χ2=1.458,P=0.227);Log rank test showed that the risk of death in the observation group was significantly lower than that in the control group(HR=0.347,95%CI 0.121-0.981,P=0.047).Conclusion CRRT combined with ulinastatin in severe sepsis patients can significantly improve symptom scores,reduce the use of vasoactive drugs,antibiotics,mechanical ventilation and ICU stay time,and reduce the risk of 28-day mortality.