乌司他丁联合阿拓莫兰治疗感染性休克患者血清白细胞介素6、肿瘤坏死因子α及降钙素原水平的变化及预后观察

Changes levels of serum interleukin 6, tumor necrosis factor αand procalcitonin and prognosis of pa-tients with septic shock with the treatment of combination of ulinastatin and Atomolan

目的：探讨乌司他丁联合阿拓莫兰治疗感染性休克患者血清IL?6、肿瘤坏死因子α（ TNF?α）及降钙素原（ PCT）水平的变化及预后。方法选取2015年5月至2016年4月我院收治的60例感染性休克患者，依据随机数表法分为乌司他丁组、阿拓莫兰组和联合组，每组20例，比较3组患者的ICU住院时间、机械通气时间及治疗后APACHEⅡ评分、治疗前后的IL?6、TNF?α、PCT、血清丙二醛（ MDA）、超氧化物歧化酶（ SOD）及预后。结果联合组患者的ICU住院时间、机械通气时间及治疗后APACHEⅡ评分均明显低于乌司他丁组、阿拓莫兰组，差异均有统计学意义（ P均＜0．05）。治疗前，3组患者的IL?6、TNF?α、PCT、MDA、SOD差异均无统计学意义（ P＞0．05）。治疗后，联合组患者的IL?6、TNF?α、PCT、MDA均明显低于乌司他丁组、阿拓莫兰组，SOD显著高于其他两组，差异均有统计学意义（ P均＜0．05）。乌司他丁组 MODS 发生率、病死率分别为30．00％（6／20）、20．00％（4／20），阿拓莫兰组分别为35．00％（7／20）、15．00％（3／20），联合组分别为5．00％（1／20）、5．00％（1／20）。联合组MODS发生率及病死率均低于其他两组（ P均＜0．05）。结论乌司他丁联合阿拓莫兰治疗感染性休克成效显著，能够明显改善患者血清IL?6、TNF?α、PCT等重要因子水平，优化患者预后，值得临床推广。

Objective To investigate the changes levels of serum interleukin 6(IL?6),tumor necrosis factor α( TNF?α) and procalcitonin( PCT) and prognosis of patients with septic shock with the treatmentof uli?nastatin and Atomolan. Methods Sixty cases patients with septic shock in Fifth Hospital Affiliated to Guang?zhou Medical University from May 2015 to April 2016 were selected,and divided into ulinastatin group,Atomolan group and combined group according to the table of random numbers,each group with 20 cases. Hospital stay in ICU,mechanical ventilation time,APACHEⅡ score after treatment,the level of IL?6,TNF?α,PCT,malondialde?hyde(MDA),superoxide dismutase(SOD) before and after treatment,and prognosis of patients of three groups were compared. Results Hospital stay in ICU,mechanical ventilation time,APACHEⅡ score after treatment of combined group were significantly lower than ulinastatin group and Atomolan group,the differences were statisti?cally significant( P<0. 05) . Before treatment,there were no significantly difference in terms of the level of IL?6, TNF?α,PCT,MDA and SOD among the patients of the three groups(P>0. 05). After treatment,the level of IL?6, TNF?α,PCT and MDA of the combined group were significantly lower than that of ulinastatin group and Atomo?lan group,while SOD was significantly higher than the other two groups,the differences were statistically signifi? cant( P<0. 05 ) . The MODS incidence, mortality rates of ulinastatin group were 30. 00%( 6/20 ) , 20. 00%(4/20),of Atomolan group were 35. 00%(7/20),15. 00%(3/20),of combined group were 5. 00%(1/20), 5. 00%( 1/20) . The MODS incidence,mortality rates of combined group were lower than the other two groups( P<0. 05).Conclusion Ulinastatin combined with Atomolan in treatment of septic shock with remarkable results, can significantly improve the serum IL?6,TNF?α,PCT and other important factors,optimize the prognosis,it is worthy of promotion.