乌司他丁联合持续性肾脏替代疗法治疗感染性休克临床效果观察  

Clinical Efficacy of Ulinastatin Combined with Continuous Renal Replacement in Treatment of Patients with Septic Shock

作　　者：虎琼华[1] 周瑜 张鸣[1] 崔巍[1] 徐治波[1] 高柯[1] 徐兵[1] 

机构地区：[1]成都市第二人民医院ICU,成都610000

出　　处：《临床误诊误治》2018年第2期56-62,共7页Clinical Misdiagnosis & Mistherapy

基　　金：四川省卫生厅科研课题(130413)

摘　　要：目的观察乌司他丁联合持续性肾脏替代疗法(continuous renal replacement therapy,CRRT)治疗感染性休克临床效果。方法选取符合纳入及排除标准的感染性休克90例,采用计算机随机数字表法随机将其分为A组、B组和C组3组各30例,A组予常规治疗,B组在常规治疗基础上予CRRT治疗,C组在常规治疗基础上予乌司他丁联合CRRT治疗。观察比较治疗前及治疗后3、7 d 3组血白细胞、降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)、血乳酸(Lac)、氧合指数(PaO_2/FiO_2)、血肌酐(SCr)、血尿素(BUN)水平及急性生理学和慢性健康状况评分系统II(APACHE II)评分,以及治疗后3、7 d病死率。结果治疗后3及7 d,3组血白细胞、PCT、CRP、IL-6、IL-10、TNF-α、Lac、SCr、BUN水平及APACHE II评分均较治疗前下降,PaO_2/FiO_2较治疗前升高,且随着治疗时间延长,血白细胞、PCT、CRP、IL-6、IL-10、TNF-α、Lac、SCr、BUN水平及APACHE II评分下降更明显,PaO_2/FiO_2升高更明显,差异具有统计学意义(P<0.05)。治疗后3及7 d,3组血白细胞、PCT、CRP、IL-6、IL-10、TNF-α、Lac、PaO_2/FiO_2、SCr、BUN水平及APACHE II评分总体比较差异均有统计学意义(P<0.05);B、C组血白细胞、PCT、CRP、IL-6、IL-10、TNF-α、Lac、SCr、BUN水平及APACHE II评分均低于A组,B、C组PaO_2/FiO_2高于A组,C组血白细胞、PCT、CRP、IL-6、IL-10、TNF-α、Lac、SCr、BUN水平及APACHE II评分低于B组,C组PaO_2/FiO_2高于B组,差异具有统计学意义(P<0.05)。治疗后3及7 d,3组病死率总体比较差异均具有统计学意义(P<0.05);B、C组病死率均低于A组,差异具有统计学意义(P<0.05)。结论乌司他丁联合CRRT治疗感染性休克可通过抑制炎症反应、清除炎性因子来增加组织再灌注血流,改善血流动力学,维持内环境稳定,从而降低病死率。Objective To observe clinical effect of Ulinastatin combined with continuous renal replacement in treatment of patients with septic shock. Methods A total of 901 patients with septic shock,who had met the inclusion and exclusion criteria,were divided into group A,B and C( n = 30 for each group) using computer random number table method.Group A was given routine therapy,and group B was added with continuous renal replacement therapy( CRRT),while group C was added with Ulinastatin combined with CRRT on the basis of routine therapy. Blood leukocytes,procalcitonin( PCT),creactive protein( CRP),interleukin-6( IL-6),interleukin-10( IL-10),tumor necrosis factor alpha( TNF-α),blood lactic acid( Lac),oxygenation index( PaO_2/FiO_2),serum creatinine( SCr),blood urea( BUN) level and acute physiology and chronic health evaluation system II( APACHE II) scores before and at 3 and 7 days after treatment,and fatality rates at 3 and7 days after treatment were observed and compared in three groups. Results In three groups,at 3 and 7 days after treatment,blood leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels,and APACHE II scores were significantly decreased,while PaO_2/FiO_2 values were significantly higher than those before treatment,and with increasing treatment time,decreased blood leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels and APACHE II scores were more obvious,while increased PaO_2/FiO_2 values were also more obvious,and the differences were statistically significant( P <0. 05). At 3 and 7 days after treatment,there were significant differences in leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,PaO_2/FiO_2,SCr and BUN levels and APACHE II scores among three groups( P < 0. 05). In group B and C,leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels,and APACHE II scores were significantly lower,while PaO_2/FiO_2 values were significantly higher than those in group A; in group C,leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels,and APACHE II scores were significantly lower,while PaO_2/FiO_2 va

关 键 词：乌司他丁 肾替代疗法 休克 脓毒性 

分 类 号：R459.7[医药卫生—急诊医学]