乌司他丁辅助高容量血液滤过对严重脓毒血症的疗效

Efficacy of ulinastatin assisted high volume hemofiltration in the treatment of severe sepsis

目的探讨乌司他丁辅助高容量血液滤过(HVHF)在临床上治疗严重脓毒血症的效果。方法选取62例严重脓毒血症患者,采用随机数字表法将患者均分为试验组和对照组,其中对照组采取HVHF治疗,试验组采用乌司他丁辅助HVHF治疗,每组31例,比较2组的疗效及相关因子水平的变化情况。结果治疗后,2组急性生理与慢性健康(APACHEⅡ)评分、多器官功能障碍综合征(MODS)评分,序贯器官衰竭估计(SOFA)评分、血清中白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、血清C反应蛋白(CRP)、细胞膜Toll样受体-4(TLR4)水平以及血清N末端B型脑钠肽(NT-proBNP)水平均明显下降,试验组变化幅度大于对照组。2组患者治疗后,CD4+、CD8+、CD4+/CD8+、CD3+、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和血小板(PLT)计数均有明显变化,其中试验组的变化幅度大于对照组,试验组患者MODS、弥漫性血管内凝血(DIC)发生率和病死率均低于对照组,差异均具有统计学意义(P<0.05)。结论乌司他丁辅助HVHF治疗严重脓毒血症效果较好,能有效改善患者的凝血功能,调节免疫细胞亚群体,提高临床治疗效果,降低死亡率。

Objective To investigate the therapeutic effect of ulinastatin in the treatment of severe sepsis with high volume hemofiltration(HVHF).Methods The patients were randomly divided into experimental group and control group.The control group was treated with HVHF.The experimental group was treated with ulinastatin-assisted HVHF,31 patients in each group,and the changes in the efficacy and related factors were compared between the 2 groups.Results After treatment,acute physiology and chronic health evaluation(APACHEⅡ),multiple organ dysfunction syndrome(MODS),sequential organ failure assessment(SOFA)scores,serum interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10)levels,C-reactionprotein(CRP),Toll-like receptor 4(TLR4)levels and N terminal pro B type natriuretic peptide(NT-proBNP)levels were significantly decreased in the 2 groups.The change range of the experimental group was greater than that of the control group.After treatment,CD4+,CD8+,CD4+/CD8+,CD3+,prothrombin time(PT),activated partial thromboplastin time(APTT)and platelet(PLT)count were significantly changed in the 2 groups,and the variation of the experimental group was greater than that of the control group.The incidence of MODS and disseminated intravascular coagulation(DIC)and mortality in the experimental group were lower than those in the control group,all differences were statistically significant(P<0.05).Conclusion Ulinastatin is effective in the treatment of severe sepsis with HVHF.It can effectively improve the coagulation function of patients,regulating immune cell subpopulations,improve the clinical treatment effect,and reduce the mortality rate.