乌司他丁联合去甲肾上腺素治疗重症脓毒症休克的疗效及对血流动力学和免疫功能的影响

Effect of ulinastatin combined with norepinephrine for severe septic shock and the impact on hemodynamics and immune function

目的 观察乌司他丁联合去甲肾上腺素治疗重症脓毒症休克的疗效及对血流动力学和免疫功能的影响。方法 选取2020年1月—2023年2月临沂市中心医院收治的重症脓毒症休克患者74例,按照随机数字表法分为对照组37例和研究组37例。对照组使用去甲肾上腺素,研究组则在对照组治疗基础上联用乌司他丁,2组均持续治疗2周。比较2组抢救结果,治疗前、治疗结束后3 d血流动力学指标[平均动脉压(MAP)、心率(HR)]、组织氧合功能指标[氧输送量(DO_(2))、氧合指数(OI)]、免疫功能指标[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)]、炎性指标[C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)]、血管内皮功能指标[内皮素-1(ET-1)、同型半胱氨酸(Hcy)]及不良反应。结果 研究组抢救成功率高于对照组(89.19%vs. 70.27%,χ^(2)=4.097,P=0.043)。治疗结束后3 d, 2组MAP、DO_(2)、OI及血清IgA、IgM水平高于治疗前,HR低于治疗前,且研究组升高/降低幅度大于对照组(P<0.01);2组血清CRP、PCT、ET-1、Hcy水平及WBC低于治疗前,且研究组低于对照组(P<0.05或P<0.01)。研究组不良反应总发生率低于对照组(8.11%vs. 29.73%,χ^(2)=5.638,P=0.018)。结论 乌司他丁联合去甲肾上腺素治疗重症脓毒症休克的效果显著,能够提高患者抢救成功率,促使机体血流动力学和组织氧合功能稳定,改善免疫功能及血管内皮功能,且安全性较高。

Objective To observe the effect of ulinastatin combined with norepinephrine for severe septic shock and the impact on hemodynamics and immune function.Methods A total of 74 patients with severe septic shock admitted to Linyi Central Hospital from January 2020 to February 2023 were selected,and they were divided into the control group and the study group according to random number table method,37 cases in each group.The control group was treated with norepinephrine,and the study group was treated with ulinastatin on the basis of the control group,both groups were treated for 2 weeks.Rescue outcome,hemodynamics indexes(MAP,HR),tissue oxygenation function indexes(DO_(2),OI),immune function indexes(IgA,IgM),inflammatory indexes(CRP,PCT,WBC),vascular endothelial function indexes(ET-1,Hcy)before treatment and at end of 3 days of treatment,and incidence of adverse reactions were compared between the two groups.Results The rescue success rate of the study group was higher than that of the control group(89.19%vs.70.27%,χ^(2)=4.097,P=0.043).At the end of 3 days of treatment,MAP,DO_(2),OI and serum levels of IgA,IgM of the two groups were higher than those before treatment,HR was lower than that before treatment,and increase/decrease range of indexes of the study group were greater than those of the control group(P<0.01);Serum levels of CRP,PCT,ET-1,Hcy and WBC of the two groups were lower than those before treatment,and the study group were lower than those of the control group(P<0.05 or P<0.01).Incidence of adverse reactions of the study group was lower than that of the control group(8.11%vs.29.73%,χ^(2)=5.638,P=0.018).Conclusion Ulinastatin combined with norepinephrine is effective in the treatment of severe septic shock,which can promote the rescue success rate of patients,stabilize hemodynamics and tissue oxygenation,improve immune function and vascular endothelial function,and with higher safety.