摘要
目的观察乌司他丁持续静脉泵入联合连续性肾脏替代疗法(CRRT)治疗多器官功能障碍综合征(MODS)的临床效果。方法选择2014年2月—2018年5月海南医学院第二附属医院重症医学科救治的MODS患者90例的资料进行回顾性分析,按救治方法不同分为2组,每组45例。对照组患者给予CRRT治疗,观察组患者在对照组患者治疗的基础上使用乌司他丁,治疗7 d后对治疗效果进行对比,并观察计算28 d病死率。结果治疗后,对照组及观察组患者的白细胞计数、降钙素原、C反应蛋白浓度均较治疗前降低(t_(对照组)=10. 531、19. 526、16. 451,t_(观察组)=28. 200,P均<0. 01,t_(观察组)=34. 421、22. 116,P均<0. 01),且观察组上述指标均低于对照组(t=14. 526、16. 573、9. 806,P均<0. 01); 2组患者的白介素-10、白介素-6、肿瘤坏死因子-α浓度均较治疗前降低(t_(对照组)=29. 260、41. 605、28. 024,t观察组=38. 357、53. 606、40. 732,P均<0. 01),且观察组均低于对照组(t=10. 979、14. 127、15. 137,P均<0. 01); 2组患者的总超氧化物歧化酶(T-SOD)、丙二醛(MDA)均增高,总抗氧化能力(T-AOC)均降低(t对照组=-6. 699、-13. 949、-4. 578,t观察组=-9. 164、2. 896、7. 262,P均<0. 01),且观察组T-SOD,MDA均高于对照组,T-AOC低于对照组(t=-8. 126、-4. 308、3. 174,P均<0. 01),28天病死率对照组为26. 67%(12/45)、观察组为17. 78%(8/45),2组比较差异无统计学意义(χ~2=1. 029,P> 0. 05)。结论使用乌司他丁持续静脉泵入联合连续性肾脏替代疗法治疗多器官功能障碍综合征的患者,可以提升治疗效果,降低炎性反应程度,值得在临床工作中推广。
Objective To investigate the clinical effect of continuous intravenous infusion of ulinastatin and continuous renal replacement therapy(CRRT)in the treatment of multiple organ dysfunction syndrome(MODS).Methods A retrospective analysis was made of 90 MODS patients treated in the Department of Intensive Critical Care Medicine,the Second Affiliated Hospital of Hainan Medical College from February 2014 to May 2018.According to different treatment methods,they were divided into 2 groups,45 cases in each group.Patients in the control group were treated with CRRT,while patients in the observation group were treated with ulinastatin on the basis of the treatment methods in the control group,and the therapeutic effect was compared.Results After treatment,the white blood cell count,procalcitonin and C-reactive protein concentrations of the two groups were decreased,and the differences were statistically significant(t=10.531,t=19.526,t=16.451,t=28.200,t=34.421,t=22.116,P<0.01).After treatment,the white blood cell count,procalcitonin and C-reactive protein in the control group were higher than those in the observation group,and the difference was statistically significant(t=14.526,t=16.573,t=9.806,P<0.01).After treatment,the concentrations of IL-10,IL-6 and TNF-αin the two groups were decreased,and the differences were statistically significant(t=29.260,t=41.605,t=28.024,t=38.357,t=53.606,t=40.732,P<0.01).After treatment,the levels of interleukin-10,interleukin-6 and tumor necrosis factor-alpha in the control group were significantly higher than those in the observation group(t=10.979,t=14.127,t=15.137,P<0.01).After treatment,total superoxide dismutase(T-SOD)and malondialdehyde(MDA)were increased and total antioxidant capacity(T-AOC)was decreased in both groups.The difference between the two groups was statistically significant(t=-6.699,t=-13.949,t=-4.578,t=-9.164,t=2.896,t=7.262,P<0.01).After treatment,the T-SOD and MDA levels in the control group were lower than those in the observation group,and T-AOC levels were higher than those in the observation group.The differences were statistically significant(t=-8.126,t=-4.308,t=3.174,P<0.01).The 28-day mortality of the control group was 26.67%(12/45),and that of the observation group was 17.78%(8/45).There was no significant difference in data between the two groups(χ2=1.029,P>0.05).Conclusion Ulinastatin continuous intravenous infusion combined with CRRT for patients with multiple organ dysfunction syndrome can improve the therapeutic effect and reduce the degree of inflammation,which is worth promoting in clinical work.
作者
孟云霞
康福新
于航
刘润
王小智
MENG Yunxia;KANG Fuxin;YU Hang;LIU Run;WANG Xiaozhi(Department of ICU,The Second Affiliated Hospital of Hainan Medical University,Hainan Province,Haikou 570311,China)
出处
《疑难病杂志》
CAS
2018年第11期1252-1255,1260,共5页
Chinese Journal of Difficult and Complicated Cases
基金
海南省自然科学基金面上项目(20168294)
