乌司他丁联合序贯透析及持续血液滤过治疗重症急性胰腺炎脓毒症休克的临床效果

Clinical Effect of Ulinastatin Combined with Sequential Dialysis and Continuous Hemofiltration on Severe Acute Pancreatitis and Septic Shock

目的 分析乌司他丁联合序贯透析及持续血液滤过治疗重症急性胰腺炎脓毒症休克的效果及安全性。方法 选取2021年1月至2023年12月收治的76例重症急性胰腺炎脓毒症休克患者,根据治疗方式不同分组,对照组38例给予乌司他丁治疗,观察组38例在对照组基础上联合序贯透析及持续血液滤过治疗。比较2组治疗情况、不良反应以及治疗前后急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、高迁移率族蛋白B1(HMGB1)、肥胖抑制素水平。结果 观察组血淀粉酶恢复正常时间、胃肠功能恢复正常时间、尿淀粉酶恢复正常时间、住院时间均短于对照组,不良反应发生率低于对照组(P<0.05)。治疗后12、24、72 h,2组APACHEⅡ评分低于治疗前,且观察组低于对照组(P<0.05)。治疗后,2组IL-6、IL-8、HMGB1、肥胖抑制素水平均低于治疗前,且观察组低于对照组(P<0.05)。结论 重症急性胰腺炎脓毒症休克患者予乌司他丁联合序贯透析及持续血液滤过治疗效果较理想,能减少不良反应及APACHEⅡ评分,减轻炎症反应,进而改善患者预后,提高了药物应用安全性。

Objective To analyze the effect and safety of Ulinastatin combined with sequential dialysis and continuous hemofiltration in the treatment of severe acute pancreatitis and septic shock.Methods From January 2021 to December 2023,76 patients with severe acute pancreatitis and septic shock were selected and divided into groups according to different treatment methods.Thirty-eight patients in the control group received Ulinastatin treatment,and 38 patients in the observation group was supplemented with sequential dialysis and continuous hemofiltration treatment on the basis of the control group.The treatment status,adverse reactions,acute physiological and chronic health evaluation scoring system Ⅱ(APACHEⅡ),interleukin-6(IL-6),interleukin-8(IL-8),high mobility group box-1 protein(HMGB1) and obestatin levels before and after treatment were compared between the two groups.Results Recovery time of blood amylase,gastrointestinal function and urine amylase and the length of hospital stay in the observation group were shorter than those in the control group,and the incidence of adverse reactions was lower than that in the control group(P<0.05).At 12,24 and 72 h after treatment,APACHEⅡ scores in the two groups were lower than those before treatment,and the observation group had lower scores than the control group(P<0.05).After treatment,the levels of IL-6,IL-8,HMGB1 and obestatin in the two groups were lower than those before treatment,and the observation group had lower levels than the control group(P<0.05).Conclusion Ulinastatin combined with sequential dialysis and continuous hemofiltration is effective in the treatment of severe acute pancreatitis and septic shock,which can reduce adverse reactions and APACHE Ⅱ scores,and alleviate inflammatory reactions,thus improving the prognosis of patients and enhancing drug safety.