摘要
目的分析乌司他丁结合低分子肝素钙的临床应用价值及对细菌感染率和血清超氧化物歧化酶(Superoxide Dismutase,SOD)、丙二醛(Malondialdehyde,MDA)水平的影响。方法将2016年8月-2018年10月间西安市第一医院收治的100例急诊重症脓毒症患者随机分为观察组及对照组;对照组采用乌司他丁治疗,观察组在对照组基础上使用乌司他丁结合低分子肝素钙治疗;记录两组重症加强护理病房(intensive Care Unit,ICU)住院时间、28 d病死率、不良反应发生率以及新发感染发生情况;治疗前后检测患者血中降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、白细胞介素-6(interieukin-6,IL-6)水平评估患者体内炎症因子水平,血衆凝血酶原时间(prothrombin time,PT)、激活的部分凝血活酶时间(actived partial thromboplastin time,APTT)、奸维蛋白原(fibrinogen,FIB)以及静脉血血小板记数(blood platelet,PLT)水平评估体内凝血功能,SOD、MDA、免疫球蛋白G(immunoglobulin G,IgG)、免疫球蛋白A(inununoglobulin A,IgA)及免疫球蛋白M(Immunoglobulin M,IgM,)水平评估免疫指标功能;采用急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluation D,APACHEⅡ)及急诊科脓毒症相关死亡率评分(mortality in emergency department score,MEDS)量表对患者临床指标进行评估。结果两组28 d死亡率及不良反应发生率无明显差异(P>0.05);观察组新发感染发生率均低于对照组,且差异具有统计学意义(PC0.05);治疗后观察组CRP、PCT、IL-6、PT、APTT、MDA水平明显低于对照组,PLT、FIB、SOD、IgG、IgA及IgM水平明显高于对照组,差异其有统计学意义(P<0.05);治疗后边察组APACHEⅡ及MEDS量表评分均明显低于对照组,差异具有统计学意义(P<0.05)。结论乌司他丁结合低分子肝素钙治疗可有效提高急诊重症脓毒症的治疗疗效,显著降低细菌感染率,并改善患者血清SOD、MDA水平。
Objective To study the clinical effects of ulinastatin combined with low molecular weight heparin in treat ment of patients with severe sepsis.Methods A total of 100 patients with severe sepsis who were admitted to the ICU between August 2016 and October 2018 were randomly divided into the control group and observation group.Patients in the control group were treated with ulinastatin.Patients in the observation group received subcutaneous injection with low molecular weight heparin calcium and also received the same treatment as the control group.ICU stay,28-day mortality,incidence of adverse reactions and the occurrence of new infections in ICU were recorded in both groups.The levels of PCT,CRP and IL-6 were measured before and after treatment.PLT,PT,APTT and FIB,indicating the coagu lation function,and SOD,MDA,IgG,IgA and IgM,identifying immune function,were also measured before and after treatment.APACHEⅡand MEDS scores were evaluated in both groups.Results There was no significant difference in 28-day mortality and adverse reactions between the two groups(P>0.05);the incidence of new infections in the obser vation group was lower than that in the control group,and the difference was statistically significant(P<0.05);CRP,PCT,IL-6,PT,PT in the observation group after treatment The levels of APTT and MDA were significantly lower than those of the control group,and the levels of PLT,FIB,SOD,IgG,IgA and IgM were significantly higher than those of the control group(P<0.05);after treatment,the scores of APACHEⅡand MEDS in the observation group were signifi cantly lower than those in the control group,and the differences were statistically significant(P<0.05).Conclusion Pa-tients who have severe sepsis treated with ulinastatin combined with low molecular weight heparin reduce incidence of new infections and had more effectively improved inflammation reaction,coagulation function and immune function.
作者
杨银娟
尚亚楠
尚向涛
YANG Yinjuan;SHANG Yanan;SHANG Xiangtao(Emergency Center,Xi'an First Hospital Xi'an,Shaanxi,710000 China)
出处
《中国急救复苏与灾害医学杂志》
2020年第3期349-352,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
作者简介
通信作者:杨银娟,E-mail:jizhe7699@163.com。
