乌司他丁联合胸腺肽α1对脓毒性休克的临床疗效观察

Clinical efficacy of ulinastatin combined with thymosin alpha 1 in the treatment of septic shock

目的观察乌司他丁(UTI)联合胸腺肽α1(Tα1)治疗脓毒性休克患者的临床效果。方法对2021年6月—2023年10月本院收治的88例脓毒性休克患者的临床资料进行回顾性分析,按照治疗方法的不同将其分为UTI组和UTI+Tα1组,每组44例。比较2组患者治疗效果、临床指标、微循环灌注指标[中心静脉血氧饱和度(S_(cv)O_(2))、血乳酸(LAC)、毛细血管再充盈时间(CRT)、平均动脉压(MAP)]、急性生理与慢性健康状况评估系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分、免疫指标、血浆及血清炎症指标[血浆可溶性髓样细胞触发受体-1(sTREM-1)、降钙素原(PCT)、白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)]及预后情况。结果治疗7 d后,UTI+Tα1组治疗有效率高于UTI组,差异有统计学意义(P<0.05)。UTI+Tα1组血管活性药物使用时间、机械通气时间、ICU入住时间、住院时间均短于UTI组,差异有统计学意义(P<0.05)。治疗24、72 h后,2组S_(cv)O_(2)、MAP逐渐升高,LAC逐渐下降,CRT逐渐缩短,差异有统计学意义(P<0.05);治疗24 h后,UTI+Tα1组S_(cv)O_(2)、MAP高于UTI组,CRT短于UTI组,差异有统计学意义(P<0.05);治疗72 h后,UTI+Tα1组CRT短于UTI组,MAP高于UTI组,差异有统计学意义(P<0.05)。治疗7 d后,2组APACHEⅡ评分、SOFA评分均较治疗前下降,且UTI+Tα1组的APACHEⅡ评分、SOFA评分均低于UTI组,差异有统计学意义(P<0.05)。治疗7 d后,2组CD3^(+)、CD4^(+)T淋巴细胞水平均较治疗前升高,且UTI+Tα1组高于UTI组,差异有统计学意义(P<0.05)。治疗7 d后,2组sTREM-1、PCT、IL-6、TNF-α水平均较治疗前下降,且UTI+Tα1组低于UTI组,差异有统计学意义(P<0.05)。随访28 d,2组病死率比较,差异无统计学意义(P=0.398)。结论UTI联合Tαl可有效促进脓毒性休克患者恢复,改善微循环灌注情况,降低血浆sTREM-1、血清PCT水平,抑制炎症反应,改善预后。

Objective To observe the clinical effect of ulinastatin(UTI)combined with thymosin alpha 1(Tαl)in the treatment of septic shock.Methods A retrospective analysis was conducted on the clinical data of 88 patients with septic shock admitted to our hospital from June 2021 to October 2023.The patients were divided into UTI group and UTI+Tα1 group according to different treatment methods,with 44 patients in each group.The treatment effects,clinical indicators,microcirculatory perfusion indicators[central venous oxygen saturation(S_(cv)O_(2)),lactate(LAC),capillary refill time(CRT),mean arterial pressure(MAP)],Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score,immune indicators,plasma and serum inflammatory indicators[soluble triggering receptor expressed on myeloid cells-1(sTREM-1),procalcitonin(PCT),interleukin(IL)-6,tumor necrosis factor-α(TNF-α)],and prognosis were compared between the two groups.Results After 7 days of treatment,the effective rate of treatment in the UTI+Tα1 group was higher than that in the UTI group(P<0.05).The duration of vasoactive drug use,mechanical ventilation time,ICU stay,and hospital stay were shorter in the UTI+Tα1 group than those in the UTI group(P<0.05).After 24 and 72 hours of treatment,S_(cv)O_(2)and MAP gradually increased,LAC gradually decreased,and CRT gradually shortened in both groups(P<0.05).After 24 hours of treatment,S_(cv)O_(2)and MAP were higher,and CRT was shorter in the UTI+Tα1 group than those in the UTI group(P<0.05).After 72 hours of treatment,CRT was shorter,and MAP was higher in the UTI+Tα1 group than those in the UTI group(P<0.05).After 7 days of treatment,both APACHEⅡand SOFA scores decreased in both groups compared to treatment before,and their scores were lower in the UTI+Tα1 group than those in the UTI group(P<0.05).After 7 days of treatment,the levels of CD3^(+)and CD4^(+)T lymphocytes increased in both groups compared to treatment before,and the levels were higher in the UTI+Tα1 group than those in the UTI group(P<0.05).After 7 days of treatment,the levels of sTREM-1,PCT,IL-6,and TNF-αdecreased in both groups compared to treatment before,and the levels were lower in the UTI+Tα1 group than those in the UTI group(P<0.05).After a 28-day follow-up,there was no statistically significant difference in mortality between the two groups(P=0.398).Conclusion UTI combined with Tαl can effectively promote the recovery of patients with septic shock,improve microcirculatory perfusion,reduce plasma sTREM-1 and serum PCT levels,inhibit inflammatory responses,and improve prognosis.