乌司他丁联合连续性肾脏替代疗法对重症脓毒症患者疗效的影响

Effects of ulinastatin combined with continuous renal replacement therapy on efficacy of patients with severe sepsis

目的:探究乌司他丁联合连续性肾脏替代疗法(CRRT)治疗重症脓毒症的疗效及对患者PCT、CRP水平和肾功能指标的影响。方法:选取确诊的重症脓毒症患者102例为研究对象,按随机数字表将患者分为观察组与对照组,各51例,对照组患者采用常规及CRRT治疗,观察组在对照组治疗基础上给予乌司他丁治疗。连续治疗14 d后评价2组患者的临床疗效、炎性指标[降钙素原(PCT)、C-反应蛋白(CRP)、血乳酸]、肾功能指标[血肌酐(SCr)、尿素氮(BUN)、血清胱抑素C(CysC)]及生理状态与器官功能评分[急性生理与慢性健康评分系统Ⅱ(APACHEⅡ)、全身感染相关性器官功能衰竭评分(SOFA)]。结果:治疗14d后临床总有效率观察组(90.20%)优于对照组的(74.51%)(P<0.05);2组患者血清PCT、CRP、乳酸水平及肾功能指标SCr、BUN、CysC均低于治疗前,且观察组低于对照组(P均<0.05);2组患者APACHEⅡ、SOFA评分均低于治疗前,且观察组低于对照组(P均<0.05)。结论:采用乌司他丁联合CRRT治疗重症脓毒症患者疗效显著,可改善患者炎性反应、肾功能损害,调节其生理状态及器官功能,提高生存率。

Objective:To explore the efficacy of ulinastatin combined with continuous renal replacement therapy(CRRT)in treatment of severe sepsis and its effects on PCT and CRP levels and renal function parameters.Methods:A total of 102 patients with severe sepsis were selected for the study and were randomly divided into an observation group and a control group,with 51 cases in each.The control group was treated with CRRT based on routine regime,and the observation group was given ulinastatin on the basis of the control group.The efficacy,inflammatory indexes[procalcitonin(PCT),C-reactive protein(CRP),blood lactate],renal function parameters[serum creatinine(SCr),urea nitrogen(BUN),serum cystatin C(CysC)]and physiological status and organs functional score[acute physiology and chronic health evaluation II(APACHE II),systemic infection-related organ failure assessment(SOFA)]were evaluated in the two groups after 14d of continuous treatment.Results:After 14d of treatment,the total effective rate in the observation group was significantly higher than that in the control group(90.20%vs 74.51%)(P<0.05).The serum levels of PCT,CRP and lactate as well as the renal function parameters of SCr,BUN and CysC in the two groups were significantly lower than those before treatment,with the levels of the observation group being significantly lower than those of the control group(P<0.05).The scores of APACHE II and SOFA in the two groups were significantly lower than before treatment,and the scores in the observation group were significantly lower than those in control group(P<0.05).Conclusion:Ulinastatin combined with CRRT has significant efficacy in the treatment of patients with severe sepsis.It has improvement effects on inflammatory response and renal dysfunction,and can regulate physiological status and organ function,and thus improve the prognosis of patients.