乌司他丁联合胸腺肽α1治疗脓毒症休克的疗效及对乳酸清除率及心肌功能的影响

The effects of ulinastatin combined with thymus α1 on the lactate clearance rate and myocardial function in patients with septic shock

目的:探讨乌司他丁联合胸腺肽α1治疗对脓毒症休克患者乳酸清除率及心肌功能的影响。方法:选择2014年3月至2016年5月本院收治的脓毒症休克患者90例,随机分为观察组和对照组,每组45例。对照组采用脓毒症休克常规治疗,观察组在对照组的基础上加用乌司他丁联合胸腺肽α1进行治疗。比较两组临床疗效、乳酸清除率、肌钙蛋白I(cTnI)、脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)及乳酸脱氢酶(LDH)水平。比较两组急性生理学与既往健康状况Ⅱ(APACHEⅡ)评分、机械通气时间、住院时间、多器官功能障碍综合征(MODS)发生率及病死率。结果:观察组治疗总有效率为95.56%,显著高于对照组的75.56%(P<0.05)。治疗后24h及72h,观察组乳酸清除率明显高于对照组,APACHEⅡ评分、机械通气时间、住院时间及cTnI、BNP、CK-MB和LDH水平低于对照组,差异均有统计学意义(P<0.05)。观察组MODS发生率和病死率均显著低于对照组(均P<0.05)。结论:乌司他丁联合胸腺肽α1治疗脓毒症休克,可有效清除乳酸,保护患者心肌功能,缩短住院时间,降低MODS发生率及病死率,值得推广应用。

Objective:To investigate the effects of ulinastatin combined with thymusα1 on the lactate clearance rate and myocardial function in patients with septic shock.Methods:A total of 90 patients with septic shock admitted to our hospital from March 2014 to May 2016 were selected,and randomly divided into an observation group and a control group,with 45 cases in each group.The patients in the control group receive conventional treatment,and those in the observation group were treated as the control group with addition of ulinastatin and thymusα1.The clinical efficacy,lactate clearance rate,and the levels of troponin I(cTnI),brain natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB)and lactate dehydrogenase(LDH)were compared between the two groups.Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,mechanical ventilation time,hospital days,the incidence of multiple organ dysfunction syndrome(MODS)and mortality rate were recorded.Results:The total effective rate in the observation group was 95.56%,which was significantly higher than that in the control group(75.56%)(P<0.05).After 24 h and 72 h of treatment,the lactate clearance rate in the observation group was significantly higher than that in the control group,while APACHEⅡscore,mechanical ventilation time,hospital days and the levels of cTnI,BNP,CK-MB and LDH were notably lower(P<0.05).The incidence of MODS and mortality rate in the observation group were lower than those in the control group(P<0.05).Conclusion:Ulinastatin combined with thymusα1 could effectively remove lactic acid,protect myocardial function,shorten hospital days,and reduce MODS and mortality rate.