乌司他丁联合连续性肾脏替代治疗对严重脓毒症患者炎症反应和血流动力学的影响

Effects of Ulinastatin Combined with Continuous Renal Replacement Therapy on Inflammatory Response and Hemodynamics in Patients with Severe Sepsis

目的:探讨乌司他丁联合连续性肾脏替代(CRRT)治疗对严重脓毒症患者炎症反应和血流动力学的影响。方法:选取2015年5月~2019年4月期间我院收治的严重脓毒症患者119例,将所有患者根据随机数字表法分为对照组(n=59)和研究组(n=60),对照组给予CRRT治疗,研究组在对照组基础上联合乌司他丁治疗,比较两组患者临床疗效、炎症反应指标、血流动力学参数,记录两组患者住院时间及28d内病死率。结果:研究组治疗7 d后的临床总有效率高于对照组(P<0.05)。两组治疗7 d后血清白介素-6(IL-6)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平均下降,且研究组低于对照组(P<0.05)。两组患者治疗7 d后心率、平均动脉压(MAP)、血乳酸下降,氧合指数升高(P<0.05),研究组治疗7 d后氧合指数高于对照组,血乳酸则低于对照组(P<0.05)。研究组住院时间短于对照组(P<0.05),两组28d内病死率比较无统计学差异(P>0.05)。结论:乌司他丁联合CRRT治疗严重脓毒症患者的疗效确切,可有效抑制机体炎症反应,改善血流动力学,减少住院时间,具有一定的临床应用价值。

Objective: To investigate the effects of ulinastatin combined with continuous renal replacement therapy(CRRT) on inflammatory reaction, hemodynamic in patients with severe sepsis. Methods: 119 patients with severe sepsis who were admitted to our hospital from May 2015 to April 2019 were selected. All patients were divided into control group(n=59) and study group(n=60) according to random number table. The control group was given CRRT treatment, and the study group was treated with ulinastatin on the basis of the control group. The clinical efficacy, inflammatory reaction indicators and hemodynamic parameters of the two groups were compared. The hospitalization time and fatality rate within 28 days were recorded. Results: The total effective rate of the study group at 7 days after treatment was higher than that of the control group(P<0.05). Serum levels of interleukin-6(IL-6), procalcitonin(PCT) and tumor necrosis factor-α(TNF-α) decreased at 7 days after treatment of both groups, and those of the study group were lower than those of the control group(P<0.05). Heart rate, mean arterial pressure(MAP), blood lactate decreased and oxygenation index increased at 7 days after treatment of the two groups(P<0.05). Oxygenation index of the study group was higher than that of the control group, while blood lactate was lower than that of the control group(P<0.05). The hospitalization time of the study group was lower than that of the control group(P<0.05), and there was no difference in the fatality rate within 28 days between the two groups(P>0.05). Conclusion: Ulinastatin combined with CRRT is effective in treating the patients with severe sepsis. It can effectively inhibit inflammation, improve hemodynamics and reduce hospitalization time. It has certain clinical application value.