乌司他丁与去甲肾上腺素联合治疗对脓毒症患者微循环的影响

Effect of ulinastatin combined with norepinephrine on microcirculation in patients with sepsis

目的探讨乌司他丁与去甲肾上腺素联合治疗对脓毒症患者微循环的影响。方法抽取2016年1月至2020年1月新乡市中心医院收治的脓毒症患者104例,按照随机数表法分为两组,对照组(52例)在常规治疗的基础上给予去甲肾上腺素治疗,观察组(52例)在对照组基础上给予乌司他丁治疗,持续治疗两周。比较两组治疗后急性生理与慢性健康(APACHEⅡ)评分,采用旁流暗视野成像技术测定患者舌下微循环变化,记录微循环指标包括灌注血管密度(PVD)、灌注血管比例(PPV)、微血管流动指数(MFI)变化,采集患者静脉血5 ml,采用酶联免疫吸附试验检测血清内皮损伤指标包括内皮素-1(ET-1)、血管性假性血友病因子(vWF)、内皮特异性分子(ESM-1),炎性指标包括肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)。结果与对照组比较,观察组治疗后APACHEⅡ评分、ET-1、vWF、ESM-1、TNF-α、IL-6水平降低(P<0.05),PVD、PPV、MFI水平增加(P<0.05)。结论乌司他丁联合去甲肾上腺素可通过降低炎症因子水平,减少内皮功能损伤,达到改善脓毒症患者微循环的目的。

Objective To investigate the effect of ulinastatin combined with norepinephrine on microcirculation in patients with sepsis.Methods A total of 104 patients with sepsis admitted to Xinxiang Central Hospital were enrolled in this study from January 2016 to January 2020.They were divided into two groups according to random number table method.The control group(52 cases)was treated with norepinephrine on the basis of conventional treatment,and the observation group(52 cases)was treated with ulinastatin based on the treatment of the control group.The two groups were given two weeks of treatment.After treatment,the acute physiology and chronic health evaluation(APACHEⅡ)scores were compared between the two groups.The changes in sublingual microcirculation were measured by sidestream dark-field imaging.The microcirculation indicators including perfused vessel density(PVD),proportion of perfused vessel(PPV),microcirculatory flow index(MFI)were recorded.Venous blood samples were collected to detect serum endothelial injury indicators including endothelin-1(ET-1),von Willebrand factor(vWF),endothelial specific molecule(ESM-1),inflammatory factors including tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)by enzyme-linked immunosorbent assay.Results After treatment,the APACHEⅡscore,levels of ET-1,vWF,ESM-1,TNF-α,IL-6 in the observation group were significantly lower than those in the control group(P<0.05),while PVD,PPV and MFI were significantly higher than those in the control group(P<0.05).Conclusions Ulinastatin combined with norepinephrine can lower the levels of inflammatory factors,and reduce endothelial injury,thereby improving microcirculation in patients with sepsis.