乌司他丁联合连续性血液净化对重症脓毒血症患者D-二聚体和降钙素原的影响

Effect of ulinastatin combined with continuous blood purification on D-dimer and procalcitonin in patients with severe sepsis

目的观察乌司他丁联合连续性血液净化对重症脓毒血症患者D-二聚体和降钙素原的影响。方法选取2017年1月-2019年2月长沙市第四医院收治的重症脓毒血症患者70例纳入研究,根据随机分组原则将其分为试验组和对照组,各35例。对照组单纯实施连续性血液净化,试验组在对照组基础上加用注射用乌司他丁。比较2组治疗总有效率,对比2组经不同治疗干预后住院时间、抗生素使用时间、急性生理与慢性健康评分,比较2组治疗前后D-二聚体和降钙素原变化情况、临床症状好转率及28 d生存率。结果治疗1周,试验组总有效率为94.29%,高于对照组的77.14%,差异有统计学意义(χ^(2)=4.200,P<0.05);试验组患者住院时间、使用抗生素治疗时间均明显短于对照组(P<0.01);治疗1周后,试验组急性生理与慢性健康评分低于对照组(P<0.01);试验组28 d生存率为88.57%,高于对照组的68.57%,差异有统计学意义(χ^(2)=4.158,P=0.041);治疗1周,2组D-二聚体水平、降钙素原水平均较治疗前降低(P<0.01),且试验组治疗后D-二聚体水平、降钙素原水平低于对照组(P<0.01);治疗后,试验组临床症状好转率为91.42%,高于对照组的71.42%,差异有统计学意义(χ^(2)=4.629,P=0.031)。结论重症脓毒血症患者实施乌司他丁联合连续性血液净化可有效降低D-二聚体和降钙素原水平,并有效改善该病症的临床表现,有助于减少血液中毒素。

Objective To observe the effect of ulinastatin combined with continuous blood purification on D-dimer and procalcitonin in patients with severe sepsis.Methods 70 patients with severe sepsis admitted to the Fourth Hospital of Changsha from January 2017 to February 2019 were selected and included in the study.According to the principle of randomization,they were divided into experimental group and control group,with 35 cases in each group.The control group was treated with continuous blood purification,and the experimental group was treated with ulinastatin for injection on the basis of the control group.The total effective rate was compared between the two groups.Compare the hospitalization time,antibiotic use time,acute physiology and chronic health scores of the two groups after different treatment interventions.Compare the changes of D-dimer,procalcitonin,the clinical symptoms of the two groups before and after treatment Improvement rate and 28-day survival rate.Results After 1 week of treatment,the total effective rate in the experimental group was 94.29%,which was higher than 77.14%in the control group(χ^(2)=4.200,P<0.05).The hospitalization time and antibiotic use time of the experimental group were significantly shorter than those of the control group(P<0.01).After 1 week of treatment,the acute physiology and chronic health scores of the experimental group were lower than those of the control group(P<0.01);the28-day survival rate of the experimental group was 88.57%,which was higher than that of the control group 68.57%(χ^(2)=4.158,P=0.041).The levels of D-dimer and procalcitonin in the two groups were lower than before treatment(P<0.01),and the levels of D-dimer and procalcitonin in the experimental group after treatment were lower than those of the control group(P<0.01).After treatment,the improvement rate of clinical symptoms in the experimental group was 91.42%,which was higher than 71.42%in the control group(χ^(2)=4.629,P=0.031).Conclusion Ulinastatin combined with continuous blood purification in patients with severe sepsis can effectively reduce the levels of D-dimer and procalcitonin,and effectively improve the clinical manifestations of the disease,helping to reduce blood toxins.