乌司他丁对脓毒症患儿血清炎症因子的影响

Effect of Ulinastatin on Serum Inflammatory Factors in Children With Sepsis

目的探讨乌司他丁对脓毒症患儿血清炎症因子的影响。方法选择2012年4月—2016年7月ICU收治的脓毒症患儿70例,根据治疗方案不同分为两组,各35例,对照组采用集束化治疗,包括抗生素、液体复苏、机械通气及营养支持等,观察组在此基础上采用乌司他丁2万U/kg+生理盐水20 mL静脉泵入,2次/d,持续治疗7 d后进行评价,比较两组间临床疗效,采血测定血清T淋巴细胞亚群和可溶性髓系细胞触发受体1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)、降钙素原(procalcitonin,PCT)含量,进行28 d随访,记录住ICU时间、死亡率及不良反应发生情况。结果对照组总有效率为77.14%,低于观察组的94.29%,比较差异有统计学意义(P<0.05);治疗后,对照组血清CD4+水平为(29.51±4.67)%,低于观察组的(34.02±4.86)%,CD8+水平为(18.04±2.35)%,高于观察组的(16.46±2.49)%,血清CD64+、sTREM-1、PCT水平分别为(34.21±5.69)%、(113.02±9.52)pg/mL、(1.25±0.51)μg/L,高于观察组的(29.02±5.17)%、(102.18±7.59)pg/mL、(0.76±0.28)μg/L,比较差异均有统计学意义(P<0.05);对照组住ICU时间为(14.53±3.21)d,长于观察组的(11.15±2.89)d,比较差异有统计学意义(P<0.05);对照组28 d死亡率为22.86%(8/35),与观察组的14.29%(5/35)比较,差异无统计学意义(P>0.05)。结论应用乌司他丁对脓毒症患儿疗效显著,降低血清TREM-1、PCT、CD64水平,提高免疫功能,预后较好,且安全性高。

Objective To explore the effect of ulinastatin on serum inflammatory factors in children with sepsis.Methods From April 2012 to July 2016,70 cases with sepsis who were admitted to the ICU were divided into two groups according to different treatment plans,35 cases each.The control group was treated with cluster therapy,including antibiotics,fluid resuscitation,mechanical ventilation and nutritional support.On this basis,the observation group was injected with ulinastatin 20 thousand U/kg+20 mL normal saline intravenously,twice a day,and evaluated after 7 days of continuous treatment.The clinical efficacy was compared,and blood samples were selected to determine levels of T lymphocyte subsets,soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT).28-day follow-up was carried out,length of stay in ICU,mortality and adverse reactions were recorded.Results The total effective rate of the control group was 77.14%,which was lower than the observation group's 94.29%.The difference was statistically significant(P<0.05).After treatment,the level of serum CD4+(29.51±4.67)%of the control group was lower than the observation group of(34.02±4.86)%,and the CD8+(18.04±2.35)%was higher than the observation group of(16.46±2.49)%,and the levels of serum CD64+,sTREM-1 and PCT were(34.21±5.69)%,(113.02±9.52)pg/mL and(1.25±0.51)μg/L,higher than(29.02±5.17)%,(102.18±7.59)pg/mL and(0.76±0.28)μg/L in the observation group,the differences were statistically significant(P<0.05).The length of stay in ICU in the control group was(14.53±3.21)d,which was longer than that in the observation group(11.15±2.89)d,the difference was statistically significant(P<0.05).The 28 day mortality in the control group was 22.86%(8/35),which had no significant difference compared with 14.29%(5/35)in the observation group(P>0.05).Conclusion Ulinastatin is effective in the treatment of sepsis,it can reduce serum TREM-1,PCT and CD64+levels,improve immune function,and having a good prognosis and high safety.