摘要
目的探讨乌司他丁分别联合连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)、血液灌流(Hemoperfusion,HP)治疗脓毒症患者的效果。方法本研究采用前瞻性随机研究方法,选取我院收治的符合纳入标准的60例脓毒症患者作为研究对象,采用随机数字表分为CRRT组和HP组各30例,两组均给予基础治疗+乌司他丁治疗,CRRT同时给予CRRT治疗,HP组给予HP治疗;对比两组治疗前后血清降钙素原(Procalcitonin,PCT)、超敏C反应蛋白(high sensitivity c-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor ne-crosis factor-α,TNF-α)、白细胞介素-6(Interleukin-6,IL-6).白细胞介素-8(Interleukin-8,IL-8).白细胞介素-10(Interleukin-10,IL-10)、肠脂肪酸结合蛋白(intestinal fatty acid binding protein,IFABP)、D-乳酸、二胺氧化酶(diamine oxidase,DAO)、急性生理功能与慢性健康评分(acute physiological function and chronic heath score,APACHEⅡ)、患者治疗结局。结果治疗前,CRRT组和HP组患者的血清PCT、hs-CRP、TNF-α.IL-6.IL-8.IL-10水平差异无统计学意义(P>0.05);治疗48h、72h,CRRT组的hs-CRP、TNF-α、JIL-8水平低于同期HP组(P<0.05);治疗48h后,CRRT组的PCTJIL-6低于同期HP组(P<0.05);治疗前,CRRT组和HP组患者的血清IFABP、D-乳酸、DAO、APACHEⅡ评分差异无统计学意义(P>0.05);治疗72h后,CRRT组的血清IFABP、D-乳酸、APACHEⅡ评分低于同期HP组(P<0.05);两组患者治疗28d观察,CRRT组的生存率73.33%与HP组患者的66.67%比较,差异无统计学意义(P>0.05)。结论乌司他丁分别联合CRRT、HP治疗脓毒症患者的效果差异不大,但是前者能尽早的清除炎症因子、改善患者的肠黏膜屏障功能。
Objective To compare the effects of ulinastatin combined with continuous renal replacement therapy(CRRT)or hemoperfusion(HP)respectively in treatment of sepsis.Methods Sixty patients with sepsis were randomly divided into 2 equal groups to undergo intravenous injection of ulinastatin at the dose of one hundred thousand intermational units(IUs)3 times/d for 7 days combined with CRRT based on the CVVHF mode in addition to the basic treatment(CRRT group)or combined with HP 3 hours a time per 24 hours for 3 times in addition to the basic treatment(HP group).Before the treatment,and 48h and 72 h after the treatment,peripheral blood samples were collected to un-dergo tests of the serum procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(L-6),interleukin-8(L-8),interleukin-10(L-10).intestinal fally acid binding protein(IF-ABP),D-lactic acid,diamine oxidase(DAO)by ELISA.Acute physiological funetion and chronie health scoring chart(APACHEⅡ)was used to evaluate the condition,and the treatment outcome was observed.Results Before treatment there were no significant differences in the serumPCT,hs-CRP,TNF-α,IL-6,IL-8,and IL-10 levels between these 2 groups(all P>0.05).The hs-CRP,TNF-α,and IL-8 levels 48h and 72 h after treatment of the CRRT group were all significantly lower than those of the HR group(all P<0.05).The PCT and IL-6 levels 48h after treatment of the CRRT group were both significantly lower than those of the HP group(both P<0.05).The levels of IFABP,D-lactic acid,and APACHEⅡscore 72 h after treatment of the CRRT group were all significantly lower than those of the HP grroup(all P<0.05).The survival rate of the CRRT group was 73.33%,not signifeantly different from that of the HP group(66.67%,P>0.05).Conclusion The effects of ulinastatin combined with CRRT or HP respectively in the treatment of sepsis are not significantly different,however,ulinastatin combined with CRRT clears the inflanmatory factors sooner and helps improve the intestinal mucosal bar
作者
黄辉权
余阶洋
彭佳华
黎辉
邓青志
HUANG Hui-quan;YU Jieyang;PENG Jiahua;LI Hui;DENG Qingzhi(Department of Intensive Medicine,Baise People's Hospital,Baise Guangxi 533000,China)
出处
《中国急救复苏与灾害医学杂志》
2021年第3期282-285,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z20190923)。
关键词
乌司他丁
连续性肾脏替代治疗
血液灌流
脓毒症
Ulinastatin
Continuous renal replacement therapy(CRRT)
Hemoperfusion(HP)
Sepsis
