乌司他丁联合连续性血液净化治疗脓毒症的疗效

Efficacy of Ulinastatin combined with continuous blood purification in patients with sepsis

目的探讨乌司他丁联合连续性血液净化治疗脓毒症患者的疗效及对患者血清C-反应蛋白(CRP)、内毒素(ETX)及肝素结合蛋白(HBP)水平的影响。方法选取2020年5月—2022年5月在沈阳市第四人民医院治疗的124例脓毒症患者,采用随机数字表法分为观察组与对照组,每组62例。对照组患者采用连续性血液净化治疗,观察组患者在对照组基础上联用乌司他丁进行治疗。比较2组患者的临床疗效,治疗前后血清相关指标、血流动力学参数、T淋巴细胞亚群指标水平及脏器功能损伤情况。结果观察组患者治疗总有效率为95.16%,高于对照组的77.42%,差异有统计学意义(χ^(2)=8.248,P=0.004)。2组患者治疗7 d后CRP、ETX、HBP、降钙素原(PCT)水平均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗7 d后心率、平均动脉压(MAP)、血乳酸水平均低于治疗前,且观察组患者血乳酸水平低于对照组,差异均有统计学意义(P<0.05);2组患者治疗7 d后氧合指数高于治疗前,且观察组高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗7 d后CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均高于治疗前且观察组高于对照组,CD8^(+)水平均低于治疗前且观察组低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗7 d后序贯器官衰竭评估(SOFA)及急性生理和慢性健康评分表(APACHEⅡ)评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05)。结论乌司他丁联合连续性血液净化治疗脓毒症疗效显著,可促进症状消退,改善血清学指标及血流动力学水平,调节免疫功能,减轻脏器损伤。

Objective To investigate the therapeutic efficacy of Ulinastatin combined with continuous blood purification on sepsis and its influence on serum C-reactive protein(CRP),endotoxin(ETX),and heparin-binding protein(HBP)levels.Methods A total of 124 patients with sepsis treated in the Fourth People's Hospital of Shenyang from May 2020 to May 2022 were randomly assigned to an observation group(n=62)and a control group(n=62).The patients in the control group received continuous blood purification and the patients in the observation group received Ulinastatin based on the control group.The clinical efficacy,serum-related indices,hemodynamic parameters,T lymphocyte subsets,and organ function injury before and after treatment were compared between the two groups.Results The overall response rate in the observation group was 95.16%,which was significantly higher than that(77.42%)of the control group(χ^(2)=8.248,P=0.004).The levels of CRP,ETX,HBP,and procalcitonin(PCT)in the 2 groups were significantly lower than those before treatment after 7 days of treatment,with the observation group lower than the control group(P<0.05).Heart rate,mean arterial pressure(MAP),and blood lactate levels were significantly lower in the 2 groups after 7 days of treatment than before treatment,with the blood lactate levels lower in the observation group than in the control group(P<0.05).The oxygenation index was significantly higher in the 2 groups after 7 days of treatment than before treatment,with the observation group higher than the control group(P<0.05).After 7 days of treatment,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the two groups were significantly higher than those before treatment and the observation group was higher than the control group,with CD8^(+)levels lower than those before treatment and the observation group lower than the control group(P<0.05).Sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation II(APACHEⅡ)scores were significantly lower after 7 days of treatment in both groups than before treatment,with the observation group lower than the control group(P<0.05).Conclusion Ulinastatin in combination with continuous blood purification is effective in treating sepsis,which is conducive to accelerating the regression of symptoms,improving serological parameters and hemodynamic levels,regulating immune function,and reducing organ injury.