乌司他丁对脓毒症合并肾损伤患者肾功能和PCT、CRP、乳酸水平的影响  

Impact of Ulinastatin on Renal Function and the Levels of PCT,CRP and Lactate in Patients with Sepsis Associated with Acute Kidney Injury

作　　者：吴佳妮[1] 向娟[1] 唐兵[1] 

机构地区：[1]成都市第六人民医院重症医学科,成都610051

出　　处：《医学综述》2017年第3期577-580,共4页Medical Recapitulate

摘　　要：目的探讨乌司他丁对脓毒症合并肾损伤患者肾功能和血清降钙素原(PCT)、C反应蛋白(CRP)、乳酸水平的影响。方法选取2014年10月至2015年10月成都市第六人民医院重症医学科收治的脓毒症合并肾损伤患者84例,根据抽签法为观察组和对照组,各42例。对照组应用常规治疗,包括抗感染、纠正水电解质平衡、净化血液、机械辅助通气、营养支持等;观察组在对照组的基础上应用乌司他丁治疗,30 U静脉滴注,每日2次。两组治疗时间均为14 d,记录两组机械通气时间、重症监护病房(ICU)入住时间、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、Marshall器官功能障碍评分及病死率。测定两组患者治疗前后血肌酐、血清胱抑素C(Cys C)、尿素氮(BUN)、PCT、CRP和乳酸水平。结果观察组患者机械通气时间、ICU入住时间均显著短于对照组[(11.3±2.4)d比(16.4±3.2)d、(14.0±2.4)d比(18.4±2.2)d,P<0.01],治疗后观察组APACHEⅡ评分、Marshall器官功能障碍评分及病死率显著低于对照组[(16.0±2.2)分比(20.4±2.3)分、(6.0±1.2)分比(7.9±1.1)分、0.0%(0/42)比16.7%(7/42),P<0.01]。观察组治疗后血肌酐、血清Cys C、BUN、PCT、CRP和乳酸水平低于对照组[(23.3±5.8)μmol/L比(34.9±6.4)μmol/L、(3.9±0.3)mg/L比(6.2±0.7)mg/L、(4.9±0.6)mmol/L比(6.3±0.6)mmol/L、(8.2±2.0)μg/L比(15.9±3.5)μg/L、(4.4±0.8)mg/L比(10.2±0.9)mg/L、(3.9±0.5)mmol/L比(5.3±0.7)mmol/L,P<0.01]。结论乌司他丁能有效提高脓毒症引起的急性肾功能损伤患者的治疗效果,改善患者病情,缩短患者ICU入住时间,降低患者病死率,其作用机制可能与乌司他丁能有效抑制PCT、CRP和乳酸水平有关。Objective To investigate the effect of ulinastatin on renal function and the levels of serum procalcitonin （PCT） , C-reactive protein（CRP） and lactate of patients with sepsis associated with acute kidney injury. Methods A total of 84 cases diagnosed as sepsis associated with acute kidney injury in Chengdu Sixth People＇s Hospital from Oct. 2014 to Oct. 2015 were included in the study and divided into an observation group（ n =42） and a control group （n =42） according to the sortation method. The control group was treated with conventional therapy, including antibiotics, correcting water and electrolyte imbalance, purifying the blood, mechanical ventilation, nutritional support, etc; the observation group was treated with ulinastatin on the basis of the control group＇s therapy,30 U intravenous infusion therapy,2 times a day. The treatment time was 14 d for both groups. The mechanical ventilation time, ICU stay time, acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ） score, Marshall organ dysfunction and mortality rates of the two groups were compared. The levels of serum creatinine, serum cystatin C （ CysC）, blood urea nitrogen （ BUN ）, PCT, CRP and lactate of the two groups before and after treatment were tested. Results The mechanical ventilation time, ICU stay time of observation group were shorter than the control group[ （11.3±2.4） d vs （ 16.4±.2） d, （ 14. 0±2.4） d vs （ 18.4±2.2） d,P 〈 0. 01 ]. After treatment, APACHE Ⅱ score, Marshall organ dysfunction and mortality rates of the observation group were significantly lower than the control group[ （ 16. 0±2.2） scores vs （20. 4±2.3） scores, （6. 0±1.2） scores vs （7.9±1.1 ） scores,0. 0% （0/42） vs 16. 7% （7/42）, P 〈 0. 01 ]. The levels of serum creatinine, CysC, BUN, PCT, CRP and lactate of the observation group after treatment were lower than the control group [ （ 23.3±5.8 ） μmol/L vs （ 34. 9±6.4 ）μmol/L, （ 3.9±0. 3 ） mg/L vs （6.2±0.7） mg/L,（4.9

关 键 词：脓毒症 乌司他丁 肾功能 降钙素原 C反应蛋白 乳酸 

分 类 号：R631[医药卫生—外科学]