摘要
目的评估肌苷对严重脓毒症患者的临床疗效。方法采用前瞻陛研究方法，选择本院2011年3月至2012年8月入住重症监护病房（ICU）的85例严重脓毒症患者，按简单随机化法分为3组。常规治疗组25例按严重脓毒症诊疗常规治疗；6h内肌苷治疗组28例，6h后肌苷治疗组32例，两组均在常规治疗基础上，每日应用肌苷1200mg（分2次静脉滴注，每次600mg，连用14d）。治疗前后取患者静脉血，检测血浆炎症冈子水平及重要器官功能指标，统计各组住ICU天数及病死率。结果与常规治疗组相比，6h内和6h后肌苷治疗组治疗后血浆促炎因子肿瘤坏死因子-α（TNF-α）、白细胞介素（IL-6）、C-反应蛋白（CRP）水平下降更明显[TNF-α（ng／L）：9．6±4．1、10．8α2．8比18．2±3．3，IL-6（ng／L）：123．0±10．1、132．0±18．4比172．0±17．9，CRP（mg／L）：42．0±10．3、45．0±8．6比61．0±12．7，均P〈0．05]，IL-10无明显差异（ng／L：53．0±9．4、56．0±10．8比58．0±11．2，均P〉0．05）；丙氨酸转氨酶（ALT）、总胆红素、B型脑钠肽（BNP）、氧合指数等器官功能指标改善也更为明显[ALT（U／L）：42．0±10．8、46．0±7．9比63．0±9．4，总胆红素（μmol／L）：16．3±6．7、18．3±7．3比28．1±8．5，BNP（ng／L）：322．0±28．7、347．0±31．4比428．0±43．2，氧合指数（mmHg，1mmHg=0．133kPa）：210．0±23．8、198．0±21．4比163．0±15．2，均P〈O．05]，2个肌苷治疗组间比较差异无统计学意义（均P〉0．05）。常规治疗组、6h内和6h后肌苷治疗组问住ICU天数（d：22．4±6．3、19．8±4．6、23．1±5．2）和病死率（36．0％、32．1％、34．4％）大致相当，两两比较差异均无统计学意义（均P〉0．05）。结论严重脓毒症患者治疗中加用常规剂量肌苷，可降低血浆炎症因子水平，促进器官功能恢复，但未能减少患者住ICU天�
Objective To evaluate the therapeutic effect of inosine in patients with severe sepsis. Methods A prospective study was conducted. Eighty-five severe sepsis patients hospitalized in intensive care unit （ICU） from March 2011 to August 2012 were included and randomized into three groups： 25 cases as conventional therapy group, who were treated with routine treatments; 28 patients were given inosine within 6 hours besides routine treatments; 32 patients were given inosine after 6 hours together with routine treatments. Inosinc was given in the latter two groups by intravenous infusion （600 mg twice a day） for 10-14 days or to the end of the research when patients died or discharged from ICU. Before or after the treatment, venous blood was collected for determination of pro-inflammatory factors and organ function parameters. Average duration of stay in ICU and mortality rate were analyzed. Results Compared with conventional therapy group, the levels of pro-inflammatory factors, such as tumor necrosis factor-ix （TNF-ct）, interleukin-6 （IL-6）, and C-reactive protein （CRP） were decreased in inosine in both within 6-hour and after 6-hour groups [TNF-α （ng/L）：9.6±4.1, 10.8±2.8vs. 18.2±3.3, IL-6 （ng/L）：123.0±10.1, 132.0±18.4vs. 172.0± 17.9, CRP （rag/L）： 42.0 ± 10.3, 45.0 ± 8.6 vs. 61.0 ± 12.7, all P〈0.05], but there was no statistical significance in the content of IL-10 （ng/L： 53.0 ± 9.4, 56.0 ± 10.8 vs. 58.0 ± 11.2, both P 〉0.05）. The lowering of alanine transaminase （ALT）, total bilirubin, B-type natriuretic peptide （BNP）, oxygenation index was more marked in inosine within 6-hour and after 6-hour groups than those of conventional therapy group [ ALT （U/L）： 42.0 ± 10.8, 46.0 ± 7.9 vs. 63.0 ± 9.4, total bilimbin （ tzmol/L）： 16.3 ± 6.7, 18.3 ± 7.3 vs. 28.1 ± 8.5, BNP （ng/L）： 322.0 ± 28.7, 347.0 ± 31.4 vs. 428.0 ± 43.2, oxygenation index （mm Hg, 1 mm Hg=0.133 kPa）： 210.0 ± 23.8, 198.0 ± 21.4 vs. 163.0 ± 15.2, all P〈
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2013年第4期204-206,共3页
Chinese Critical Care Medicine
基金
广东省医药卫生科研课题（A2011316）
关键词
肌苷
严重脓毒症
炎症因子
预后
Inosine
Severe sepsis
Inflammatory factor
Outcome
