中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (03): 182-185.doi: 10.3969/j.issn.1671-4091.2022.03.009

• 临床研究 • 上一篇    下一篇

乌司他丁联合连续性血液净化治疗重症脓毒症效果研究

唐佳佳1,管义祥2   

  1. 江苏省海安市人民医院1 药剂科2神经外科
  • 收稿日期:2021-08-12 修回日期:2021-12-20 出版日期:2022-03-12 发布日期:2022-03-16
  • 通讯作者: 管义祥 1663022943@qq.com E-mail:mah3941@163.com

The effect of ulinastatin combined with continuous blood purification in the treatment of severe sepsis and its influence on microcirculation indexes, plasma polysaccharide coating level and prognosis

  1. 1Department of Pharmacy and 2Department of Neurosurgery, Hai'an City People's Hospital, Nantong 226600, China
  • Received:2021-08-12 Revised:2021-12-20 Online:2022-03-12 Published:2022-03-16

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摘要： 【摘要】目的探讨乌司他丁联合连续性血液净化(continuous blood purification，CBP)治疗重症脓毒症效果及对微循环指标、血浆多糖包被水平及预后的影响。方法选择2017 年8 月～2020 年1 月江苏省海安市人民医院收治的130 例重症脓毒症患者，依据治疗方式将其分为观察组(乌司他丁+CBP，n=78)和对照组(单纯CBP，n=52)。对比分析2 组病情改善指标及治疗前后微循环指标、血浆多糖包被水平，记录2 组并发症发生率及28d 病死率以评价预后情况。结果与对照组相比，观察组治疗后序贯器官衰竭评分表(sequential organ failure assessment，SOFA)评分(t=7.835，P＜0.001)、急性生理学与慢性健康状态Ⅱ评分(t=8.264，P＜0.001)、舌下总血管密度(t=8.101，P＜0.001)、舌下灌注血管密度(t=3.905，P＜0.001)、血浆透明质酸(t=2.216, P=0.028)、血浆多配体蛋白聚糖-1 (t=6.792, P<0.001)、血浆硫酸类肝素(t=3.457, P=0.001)、血清降钙素原(t=2.994, P=0.003)、血清白细胞介素-6(t=9.003, P＜0.001)和血清白细胞介素- 17(t=6.414, P＜0.001)均降低，观察组舌下灌注血管比例(t=4.739, P＜0.001)和舌下流动指数(t=2.467，P=0.015)较高；观察组住院天数及28d 病死率均短/低于对照组(t/χ2=2.219，4.670；P=0.028，0.031)。结论在CBP 治疗基础上对重症脓毒症患者使用乌司他丁可改善机体微循环状态、缓解机体炎症反应程度、抑制血浆多糖包被降解，并能显著改善患者短期及长期预后。

关键词: 乌司他丁, 连续性血液净化, 重症脓毒症, 微循环, 多糖包被, 疾病预后

Abstract: 【Abstract】Objective To investigate the effect of ulinastatin combined with continuous blood purification (CBP) in the treatment of severe sepsis and its effects on microcirculation indexes, plasma polysaccharide coating level and prognosis. Methods A total of 130 patients with severe sepsis treated in our hospital from August 2017 to January 2020 were divided into observation group (Ulinastatin+CBP, n=78) and control group (CBP, n=52). The disease improvement indexes, microcirculation indexes and plasma polysaccharide coating level before and after the treatment were compared between the two groups. The incidence of complications and 28-day mortality in the two groups were recorded to evaluate their prognosis. Results Compared with the control group, the scores of sequential organ failure assessment (t=7.835, P＜0.001), acute physiology and chronic health status II (t=8.264, P＜0.001), total sublingual vascular density (t=8.101, P＜0.001), sublingual perfusion vascular density (t=3.905, P＜0.001), plasma hyaluronic acid (t=2.216, P=0.028), plasma multi ligand proteoglycan- 1 (t=6.792, P＜0.001), plasma heparan sulfate (t=3.457, P=0.001), serum procalcitonin (t=2.994, P=0.003), serum interleukin-6 (t=9.003, P＜0.001) and serum interleukin-17 (t=6.414, P＜0.001) decreased significantly in the observation group after the treatment; the proportion of sublingual perfusion vessels (t=4.739, P＜0.001) and sublingual flow index (t=2.467, P=0.015) were higher in the observation group; the hospitalization period was shorter (t=2.219, P=0.028) and the 28-day mortality (χ2=4.670, P=0.031) was lower in the observation group. Conclusion CBP treatment combined with the administration of ulinastatin can improve the microcirculation state, alleviate the inflammatory reaction, inhibit the degradation of plasma polysaccharide, and significantly improve the short-term and long-term prognosis of the patients with severe sepsis.

Key words: Ulinastatin, Continuous blood purification, Severe sepsis, Microcirculation, Polysaccharide coating, Disease prognosis

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