[1]夏胜兵,张国秀.高剂量与常规剂量乌司他丁联合血必净治疗脓毒症的临床疗效分析[J].第三军医大学学报,2018,40(16):1512-1517.
 XIA Shengbing,ZHANG Guoxiu.Clinical efficacy of high versus regular dose of ulinastatin combined with Xuebijing for treatment of sepsis[J].J Third Mil Med Univ,2018,40(16):1512-1517.
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高剂量与常规剂量乌司他丁联合血必净治疗脓毒症的临床疗效分析(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第16期
页码:
1512-1517
栏目:
临床医学
出版日期:
2018-08-30

文章信息/Info

Title:
Clinical efficacy of high versus regular dose of ulinastatin combined with Xuebijing for treatment of sepsis
作者:
夏胜兵张国秀
河南科技大学临床医学院;解放军第150中心医院重症医学科
Author(s):
XIA Shengbing ZHANG Guoxiu

College of Clinical Medicine of Henan University of Science and Technology, Luoyang, Henan Province, 471000; Department of Intensive Care Unit , No. 150 Central Hospital of PLA, Luoyang,  Henan Province, 471000, China

关键词:
脓毒症乌司他丁临床疗效
Keywords:
sepsis ulinastatin clinical efficacy
分类号:
R631; R969.4; R977.6
文献标志码:
A
摘要:

目的    观察高剂量乌司他丁(UTI)是否较常规剂量UTI联合血必净用药对脓毒症患者的临床疗效更为显著。方法    对2016年5月到2017年5月河南科技大学临床医学院及解放军第150中心医院重症医学科收治的150例[包括男性86例,女性64例,年龄22~49(41.7±5.1)岁],第一诊断为脓毒症的患者进行前瞻性随机对照研究,按随机数字表法分为对照组、常规剂量UTI组(LD组)以及高剂量UTI组(HD组),每组50例。对照组按照脓毒症治疗指南进行常规治疗,LD组加用常规剂量乌司他丁(5 000 U·kg-1·d-1)和血必净(200 mL/d)静脉滴注治疗,7 d为一疗程。HD组将UTI剂量提升为25 000 U·kg-1·d-1。在治疗后第0、3、7天抽血检测血浆和肺泡灌洗液中肿瘤坏死因子(tumor necrosis factor alpha, TNF-α)、白细胞介素-6(interleukin-6,IL-6)、C-反应蛋白(CRP)、降钙素原(PCT)水平,外周血CD4+、CD8+、CD4+/CD8+值,动脉血氧分压[ρ(O2)]、二氧化碳分压[ρ(CO2)]、乳酸(Lac)、肺泡动脉氧分压差(A-aDO2),心脏排血指数(CI)、心脏输出量(CO)和外周血管阻力(SVR),计算急性生理与慢性健康评分(APACHEⅡ),统计机械通气时间、ICU住院时间以及28 d死亡率。结果3组患者在治疗后0 h各项指标差异无统计学意义(P>0.05);在治疗后第3、7天,LD组和HD组均可显著降低患者TNF-α、IL-6、CRP、PCT水平,提高CD4+、CD8+、CD4+/CD8+值(P<0.05),改善ρ(O2)、ρ(CO2)、Lac、AaDO2、CO、CI、SVR(P<0.05),明显降低APACHEⅡ评分,缩短机械通气和ICU住院时间,降低临床死亡率(P<0.05)。HD组对各项指标的改善作用显著大于LD组。结论    UTI联合血必净治疗脓毒症可改善临床症状及预后,且高剂量UTI较常规剂量UTI更能够发挥显著保护效应,其作用可能与高剂量UTI可更有效降低炎症介质水平、纠正免疫抑制和改善脏器功能有关。
 

Abstract:

Objectiv    eTo compare the efficacy of high-dose versus regular-dose ulinastatin (UTI) combined with Xuebijing in the treatment of sepsis. Methods    This randomized controlled trial was conducted in 150 patients (including 86 male and 64 female patients with a mean age of 41.7±5.1 years) admitted with the diagnosis of sepsis in our 2 hospitas between May, 2016 and May, 2017. The patients were randomized to receive routine treatment (control group) or UTI treatment at a regular (5 000 U·kg-1·d-1) or a high dose (25 000 U·kg-1·d-1) combined with daily intravenous infusion of 200 mL Xuebijing. At 0, 3, and 7 d of treatment, the patients were examined for levels of TNF-α, IL-6, C-reactive protein (CRP), procalcitonin (PCT), CD4+ and CD8+ cells, PaO2, PaCO2, Lac, arterial oxygen partial pressure (A-aDO2), cardiac functions, and peripheral vascular resistance (SVR); APACHE-II score, mechanical ventilation time, ICU stay and the mortality rate at 28 d were also recorded in these patients. Results    The 3 groups were comparable for the baseline parameters before the treatment (P>0.05). Compared with the regular dose group, the patients receiving high-dose UTI treatment showed significantly decreased levels of TNF-α, IL-6, CRP, and PCT, increased CD4+ and CD8+ cell percentages and CD4+/CD8+ ratio (P<0.05), and improved PaO2, PaCO2, Lac, AaDO2, CO, CI, and SVR (P<0.05). Treatment with high-dose UTI was associated with a shortened mechanical ventilation time and ICU stay and significant reductions in APACHE-II score and mortality rate at 28 days (P<0.05). Conclusion    Treatment with UTI combined with Xuebijing can significantly improve the clinical symptoms and the prognosis of sepsis, and a high dose of UTI can produce better protective effects.

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更新日期/Last Update: 2018-09-03