乌司他丁联合序贯透析、持续血滤治疗重症急性胰腺炎致脓毒症休克疗效研究

Effect of ulinastatin combined with sequential dialysis and continuous hemofiltration in the treatment of septic shock caused by severe acute pancreatitis

目的探讨乌司他丁联合序贯透析、持续血滤治疗重症急性胰腺炎(SAP)所致脓毒症休克的疗效,并分析其对血清炎症因子、高迁移率族蛋白1(HMGB1)、肥胖抑制素(Obestatin)及肝肾功能的影响。方法选取自2019年1月至2021年8月收治的70例SAP所致脓毒症休克患者为研究对象,按照随机数字表法分为A组(n=35)与B组(n=35)。A组给予乌司他丁治疗,B组在A组基础上创建体外循环,进行序贯透析、持续血滤治疗。两组患者均治疗7 d,评估并比较两组患者临床疗效。记录并比较两组患者治疗前、治疗后急性生理与慢性健康评分(APACHEⅡ),序贯器官衰竭(SOFA)评分,血清炎症因子[白细胞介素6(IL-6)、白细胞介素8(IL-8)、肿瘤坏死因子α(TNF-α)]、HMGB1、Obestatin水平,及肝肾功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、血肌酐(SCr)、血尿素氮(BUN)]。记录并比较两组患者28 d病死率。结果治疗后,B组总有效率为91.4%(32/35),高于A组的71.4%(25/35),差异有统计学意义(P<0.05)。治疗后,两组APACHEⅡ评分、SOFA评分及血清IL-6、IL-8、TNF-α、HMGB1、Obestatin、ALT、AST、BUN、SCr水平均较治疗前降低,且B组低于A组,差异有统计学意义(P<0.05)。B组28 d病死率为8.6%(3/35),低于A组的28.6%(10/35),差异有统计学意义(P<0.05)。结论乌司他丁联合序贯透析、持续血滤可有效缓解SAP所致脓毒症休克患者炎症反应,促进病情恢复,改善患者预后。

Objective To investigate the efficacy of ulinastatin combined with sequential dialysis and continuous hemofiltration in the treatment of septic shock caused by severe acute pancreatitis(SAP),and to analyze its effect on serum inflammatory factors,high mobility group box 1(HMGB1),Obestatin and liver and kidney function.Methods A total of 70 patients with SAP-induced septic shock admitted from January 2019 to August 2021 were selected and divided into group A(n=35)and group B(n=35)according to random number table method.The patients in group A were treated with ulinastatin,while the patients in group B were established extracorporeal circulation and received sequential dialysis and continuous hemofiltration on the basis of the treatment of group A.Both groups were treated for 7 days,and the clinical efficacy of the two groups was evaluated and compared.Acute physiology and chronic health scores(APACHEⅡ),sequential organ failure(SOFA)scores,serum inflammatory factors[interleukin 6(IL-6),interleukin 8(IL-8),tumor necrosis factorα(TNF-α)],HMGB1,Obestatin,and liver and kidney function indicators[aspartate aminotransferase(AST),alanine aminotransferase(ALT),serum creatinine(SCr),blood urea nitrogen(BUN)]were recorded and compared between the two groups before and after the treatment.The 28-day mortality was recorded and compared between the two groups.Results After the treatment,the total effective rate of group B was 91.4%(32/35),which was higher than that of group A[71.4%(25/35)],the difference was statistically significant(P<0.05).After the treatment,APACHEⅡscore,SOFA score and the levels of serum IL-6,IL-8,TNF-α,HMGB1,Obestatin,ALT,AST,BUN and SCr of the two groups were lower than those before the treatment,and those of group B were lower than those of group A,the differences were statistically significant(P<0.05).The 28-day mortality of group B was 8.6%(3/35),which was lower than that of group A[28.6%(10/35)],and the difference was statistically significant(P<0.05).Conclusion Ulinastatin combined with sequential dialysis and continuous hemofiltration can effectively relieve the inflammatory reaction of patients with SAP-induced septic shock,promote the recovery of the disease and improve the prognosis of the patients.