摘要
目的观察血必净和乌司他丁不同使用方法对多发伤患者血清炎症因子水平的影响,以探索对多发伤患者的更好的药物治疗方案,提高治疗效果。方法选择多发伤患者145例,随机分为常规治疗组(A组)34例、血必净治疗组(B组)35例、乌司他丁治疗组(C组)37例、血必净联合乌司他丁治疗组(D组)39例,常规组积极处理原发病,循环呼吸支持、止血、输血、输液、抗感染和营养支持等。B组在此基础上加用血必净注射液100 ml每12 h 1次,连续用药5 d。C组加用乌司他丁针20万U静滴,每12 h 1次,5 d为一疗程。D组加用血必净注射液100 ml静滴,每12 h 1次+乌司他丁20万U静滴,每12 h 1次,5 d为一疗程。4组患者均于第0、12、24、36、48、72、96、120小时采用ELISA法测定血清IL-6、IL-8,放射免疫法测定TNF-α。并观察、统计和总住院时间、ICU住院时间及28 d生存率。用SPSS 13.0统计学软件处理。以P<0.05为差异有统计学意义。结果 A组TNF-α、IL-6、IL-8在各个时段持续升高,而B组、C组及D组在36~48 h之后开始逐步下降。在96 h、120 h时段,D组下降幅度较B组、C组显著(P<0.05),而B组与C组差异无统计学意义(P>0.05)。4组患者的住ICU时间差异无统计学意义。与常规组比较,血必净组、乌司他丁组的总住院时间略缩短,但差异无统计学意义;而联合组的总住院时间显著缩短(P<0.05)。4组患者的28 d病死率差异无统计学意义。结论血必净或乌司他丁单独使用均可有效抑制血清炎症因子,使TNF-α、IL-6、IL-8下降,但对缩短总住院时间、住ICU院时间和降低病死率无影响。两者联合应用使血清炎症因子水平下降更为明显,虽然对住ICU院时间和降低病死率无影响,但可以明显缩短总住院时间。提示两者联合应用,具有协同作用,可以提高疗效。
Objective To explore the influence of Xuebijing combined with ulinastatin on the levels of serum inflammatory factors in patients with multi-injures, modify the dosage regime and improve the curative efficacy. Methods Total 145 multi-injury patients were randomly divided into conventional therapy group（ group A, n = 34） , Xuebijing group（ group B, n = 35 ）, ulinastatin group （ group C, n = 37 ）, and Xuebijing combined with ulinastatin group （ group D, n = 39 ）. The group A was treated according to the therapy guideline of multi-injury, including improving prime diseases, blood transfusion, in- fusion, anti-infection and nutritional support, etc. group B received additional i.v. Xuebijing injection 100 ml twice a day for 5 days ; group C received additional i.v. ulinastatin 200 000 Units twice a day for 5 days ; group D received additional i.v. Xuebijing injection 100 ml and ulinastatin 200 000 Units twice a day for 5 days. The levels of TNF^（ by radioimmu- noassay） ,IL-6 and IL-8（by ELISA） before the treatment and on 12th,24th,48th,36th,72th,96th, 120th hour after the treatment were tested in all patients. The hospital stay, days in ICU and 28-day survival rate were compared among the four groups. SPSS 13.0 statistics software was employed to analyze the data with P 〈 0.05 as the Statistically significant differences. Results The plasma levels of TNF-α, IL-6 and IL-8 in group A increased continuously in each time points, but in group B, group C and group D descended gradually from 36 h or 48 h time points, in group D was more obviously from 96 h and 120 h time points （P 〈 0.05 ） , but the different between group B and group C was not significant（ P 〉 0.05 ）. There was no difference in ICU stay among the four groups（ P 〉 0.05 ）. The hospital stay of group D was less as compare to those of other groups （ P 〉 0. 05 ）. No difference in the 28-day survival rate was found （ P 〉 0.05 ）. Conclusion Xuebijing or ulinastatin can independently inhibit the expression of inflammatory factors, decrease the levels of TNF-α, IL-6 and IL-8. They have no utility on shortening the stay days in hospital and ICU and decrease the mortality. The combination of Xuebi-jing and ulinastatin can more obviously decrease the levels of inflammatory factors, shorten the hospital stay, this implies the two drugs have synergism which should improve the therapeutic efficacy.
出处
《中华全科医学》
2014年第12期1888-1890,共3页
Chinese Journal of General Practice
基金
卫生部卫生公益性行业科研专项课题(201002014)
浙江省瑞安市科技局资助课题(201203091)
关键词
多发伤
血必净
乌司他丁
炎症因子
Multi-injury patients
Xuebijing injection
Ulinastatin
Inflammatory factor
