摘要
目的探讨乌司他丁在多发伤并发脓毒症病人临床治疗中的应用效果。方法回顾性分析2017年4月至2019年4月苏州第九人民医院收治的106例多发伤并发脓毒症病人病例资料,根据治疗方式的不同将所有病人分为两组,各53例。对照组仅予以抗感染等常规治疗,观察组在对照组基础上加用乌司他丁静脉滴注治疗,2次/天。两组均连续给药1周。比较两组病人炎症状态、T细胞亚群变化情况、血流动力学参数及临床治疗总有效率。结果治疗后两组病人各血清炎性因子水平超敏C反应蛋白(hs-CRP)、血清肿瘤坏死因子α(TNF-α)、降钙素原及白细胞介素-6(IL-6)均有所降低,且观察组低于对照组[(20.85±3.06)mg/L比(38.16±4.27)mg/L,(21.94±3.18)mg/L比(33.05±4.16)mg/L,(0.71±0.32)g/L比(1.29±0.44)g/L,(215.63±28.49)ng/L比(279.14±36.85)ng/L,P<0.05];与治疗前相比,两组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均有所提高,CD8^(+)均降低,且观察组CD3^(+)(60.12±9.84)%比(47.08±7.35)%、CD4^(+)(44.96±8.15)%比(44.96±8.15)%、CD4^(+)/CD8^(+)(1.59±0.83)比(1.17±0.69)指标高于照组,CD8^(+)(27.04±5.39)%比(33.07±6.22)%指标低于对照组(P<0.05);治疗后两组病人心脏指数、每搏量指数(SVI)、全心舒张期末容积指数(GEDVI)、平均动脉压(MAP)及中心静脉压(CVP)均高于治疗前,心率低于治疗前,且观察组心脏指数、SVI、GEDVI、MAP及CVP指标高于对照组,心率指标低于对照组(P<0.05)。观察组总有效率94.34%(50/53)与对照组总有效率90.57%(48/53)相比,差异无统计学意义(χ^(2)=0.541,P=0.462)。结论将乌司他丁用于多发伤并发脓毒症病人治疗中可有效帮助其降低机体炎性反应,同时改善免疫功能及血流动力学参数,临床疗效确切。
Objective To explore the effect of Ulinastatin in the clinical treatment of patients with multiple trauma complicated with sepsis.Methods We retrospectively analyzed the case data of 106 patients with multiple injuries and sepsis admitted to The Ninth People's Hospital of Suzhou from April 2017 to April 2019.According to the different treatment methods,all patients were assigned into two groups,with 53 cases in each.The control group was only given conventional treatment such as anti-infection,and the observation group was treated with additional ulinastatin intravenous drip twice a day on the basis of the therapy in the control group.Both groups were continuously administered for 1 week.The inflammatory status,T cell subset changes,hemodynamic parameters and the total effective rate of clinical treatment were compared between the two groups.Results After treatment,the levels of serum inflammatory factors,high sensitivity C-reactive protein(hs-CRP),tumor necrosis factorα(TNF-α),procalcitonin and interleukin-6(IL-6),were decreased in both groups,and the levels in the observation group were lower than those in the control group[(20.85±3.06)mg/L vs.(38.16±4.27)mg/L,(21.94±3.18)mg/L vs.(33.05±4.16)mg/L,(0.71±0.32)g/L vs.(1.29±0.44)g/L,(215.63±28.49)ng/L vs.(279.14±36.85)ng/L,P<0.05].In comparison with pre-treatment,the levels of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were increased,and the levels of CD8^(+)were decreased in both groups.The levels of CD3^(+)[(60.12±9.84)%vs.(47.08±7.35)%],CD4^(+)[(44.96±8.15)%vs.(44.96±8.15)%],CD4^(+)/CD8^(+)[(1.59±0.83)vs.(1.17±0.69)]in the observation group were higher than those in the control group and the level of CD8^(+)[(27.04±5.39)%vs.(33.07±6.22)%]in the observation group was lower than that in the control group(P<0.05).After treatment,the heart index(CI),stroke volume index(SVI),global end-diastolic volume increases(GEDVI),mean arterial pressure(MAP),and central venous pressure(CVP)of all patients in both groups increased,and the heart rate(HR)decreased in comparison with pretreatment.The levels of CI,SVI,GEDVI,MAP and CVP in the observation group were higher than those in the control group,and HR in the observation group was lower than that in the control group(P<0.05).The total response rate in the observation group was 94.34%(50/53),lower than that in the control group,which was 90.57%(48/53);there was no statistically significant difference between the two groups(χ^(2)=0.541,P=0.462).Conclusion For patients with multiple trauma complicated with sepsis,Ulinastatin can effectively help reduce the inflammatory response of the body,and improve the T cell subsets and hemodynamic parameters,which achieves certain clinical effects.
作者
金冬林
JIN Donglin(Department of Emergency,The Ninth People's Hospital Suzhou,Suzhou,Jiangsu 215200,China)
出处
《安徽医药》
CAS
2021年第9期1889-1892,共4页
Anhui Medical and Pharmaceutical Journal
