乌司他丁对创伤失血性休克后胃肠功能障碍合并MODS患者炎症因子水平影响

Effect of Ulinastatin on inflammatory factors in patients with gastrointestinal dysfunction and MODS after traumatic hemorrhagic shock

目的分析乌司他丁对创伤失血性休克后胃肠功能障碍合并多器官功能衰竭综合征(MODS)患者炎症因子水平的影响。方法笔者医院2016年4月—2018年2月收治创伤失血性休克后胃肠功能障碍合并MODS患者68例,根据治疗方法不同分为常规治疗组和乌司他丁组(各34例)。常规治疗组患者采用常规治疗,乌司他丁组患者采用常规治疗+乌司他丁治疗,观察两组患者住ICU时间、28d病死率及治疗前、治疗3、7d胃肠功能评分、急性生理学与慢性健康状况(APACHEⅡ)评分、白介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、白介素-10(IL-10)、内毒素、纤维蛋白原(FIB)、二胺氧化酶水平变化情况。结果乌司他丁组患者住ICU时间和28d病死率分别为(11. 26±3. 12) d、11. 76%(4/34),常规治疗组分别为(15. 22±3. 69) d、23. 53%(8/34),组间比较差异有统计学意义(P <0. 05)。治疗前,两组患者胃肠功能评分、APACHEⅡ评分比较,差异无统计学意义(P> 0. 05)。治疗3d时,乌司他丁组胃肠功能评分(2. 20±0. 63)分、APACHEⅡ评分(19. 22±3. 13)分低于常规治疗组;治疗7d时,乌司他丁组胃肠功能评分(1. 55±0. 72)分、APACHEⅡ评分(13. 12±2. 28)分低于常规治疗组,差异有统计学意义(P <0. 05)。治疗前,两组患者IL-1β、TNF-α、IL-10、内毒素、FIB、二胺氧化酶水平比较,差异无统计学意义(P> 0. 05)。治疗3、7d,乌司他丁组患者IL-1β、TNF-α、IL-10、内毒素、二胺氧化酶水平低于常规治疗组,FIB水平高于常规治疗组,差异有统计学意义(P <0. 05)。结论乌司他丁治疗创伤失血性休克后胃肠功能障碍并MODS患者可减轻患者炎症反应,缩短住ICU时间,降低病死率。

Objective To analyze the effect of Ulinastatin on inflammatory factors in patients with gastrointestinal dysfunction and multiple organ failure syndrome(MODS)after traumatic hemorrhagic shock.Methods From Apr.2016to Feb.2018,68patients with gastrointestinal dysfunction associated with MODS after traumatic hemorrhagic shock were divided into two groups:control group and observation group.The patients in the control group were treated with routine therapy,and the patients in the observation group were treated with Ulinastatin and routine therapy.The duration of ICU,the28-d fatality rate,the scores of gastrointestinal function,acute physiology and chronic health status(APACHEⅡ),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α)before and after treatment were observed.Changes of interleukin-10(IL-10),endotoxin and fibrinogen(FIB),diamine oxidase levels were observed.Results The duration of ICU and the28d fatality rate were(11.26±3.12)d and11.76%in the observation group,and(15.22±3.69)d and23.53%in the control group.There was significant difference between the two groups(P<0.05).Before treatment,there was no significant difference in gastrointestinal function score and APACHEⅡscore between the two groups(P>0.05).After3d of treatment,the scores of gastrointestinal function and APACHEⅡin the observation group were(2.20±0.63)and(19.22±3.13),respectively,which were lower than those in the control group.After7d of treatment,the scores of gastrointestinal function and APACHEⅡin the observation group were(1.55±0.72)and(13.12±2.28),lower than those in the control group(P<0.05).Before treatment,the levels of IL-1β,TNF-α,IL-10,endotoxin,FIB and diamine oxidase were not significantly different between the two groups(P>0.05).After3d and7d of treatment,the levels of IL-1β,TNF-α,IL-10,endotoxin and diamine oxidase in the observation group were lower than those in the control group,and the FIB level was higher than that in the control group(P<0.05).Conclusion Ulinastatin in the treatment of patients with gastrointestinal dysfunction and MODS after traumatic hemorrhagic shock can relieve the inflammatory reaction,shorten the duration of ICU,and reduce the death rate.