乌司他丁使用剂量和时间与严重脓毒症患者预后的关系  

Relationship between ulinastatin administration and prognosis of patients with severe sepsis

作　　者：陈坤[1] 李文放[1] 林兆奋[1] 

机构地区：[1]第二军医大学长征医院急救科,上海200003

出　　处：《第二军医大学学报》2015年第6期644-648,共5页Academic Journal of Second Military Medical University

摘　　要：目的探讨乌司他丁使用剂量和时间与严重脓毒症患者预后的相关性。方法回顾性分析从2010年1月至2014年4月长征医院重症监护室收治的脓毒症患者,收集入院24h内血常规、C反应蛋白(CRP)、胆红素、降钙素原(PCT)、凝血功能等,并统计APACHEⅡ。依据是否使用乌司他丁分为乌司他丁组及对照组,比较两组间患者病死率差异;并通过亚组分析探讨乌司他丁使用剂量、疗程与病死率的相关性。结果 134例患者中,共死亡36例(26.9%)。其中39例使用乌司他丁,乌司他丁组与对照组病死率分别为33.3%(13/39)和24.2%(23/95),差异无统计学意义;亚组分析提示APACHEⅡ评分≥25分的患者中,乌司他丁组和对照组病死率分别为44.4%(4/9)和90.0%(9/10),差异有统计学意义(P<0.05)。死亡病例与存活病例乌司他丁使用总量分别为(698.46±253.57)万U和(1 030.38±633.19)万U,使用时间分别为(7.54±3.02)d和(14.57±6.14)d,差异均有统计学意义(P<0.05或P<0.01)。结论对于APACHEⅡ评分≥25的脓毒症患者早期足量使用乌司他丁可以改善预后。Objective To study the relation of ulinastatin administration（dose and course）with the prognoses of patients with severe sepsis.Methods We retrospectively analyzed the clinical data of selected patients with sepsis,who were treated in the ICU of Changzheng Hospital from January 2010 to April 2014.The blood routine examination,C-reactire protein（CRP）,bilirubin,procalcitonin（PCT）,and coagulation function were collected within 24 hours after hospitalization,and APACHE Ⅱwas calculated.The patients were grouped into ulinastatin group or the control group.The survival rates were compared between the two groups,and the relationship between ulinastatin（dose/course）and death rate was discussed.Results A total of 134 patients were included,with a mean age of（53.8±17.2）years old.Thirty-six patients（26.9%）died.Thirty-nine patients used ulinastatin;the death rates in the ulinastatin group and the control group were 33.3%（13/39）and 24.2%（23/95）,respectively,showing no significant difference（P〉0.05）.The death rates of the patients with APACHE Ⅱ ≥25were44.4%（4/9）in the ulinastatin group and 90.0%（9/10）in the control group,showing significant difference（P〈0.05）.The total dose of ulinastatin was（6.984 6±2.535 7）million unit in the death group and（10.303 8±6.331 9）million unit in the survival group,and the application course was（7.54±3.02）days vs（14.57±6.14）days,both showing significant differences（P〈0.05 or P〈0.01）.Conclusion Megadosing ulinastatin at an early stage can improve the prognosis of sepsis patients with APACHEⅡ≥25.

关 键 词：脓毒症 乌司他丁 APACHEⅡ评分 死亡率 

分 类 号：R631[医药卫生—外科学]