【摘要】 目的 探讨乌司他丁联合(continuous renal replacementtherapy,CRRT)在感染性休克患者中应用价值。方法选取ICU收治的感染性休克患者60名,签署知情同意书。按照随机数字法均分为:A组(常规治疗组)、B组(常规治疗加血液净化治疗)、C组(常规治疗加乌司他丁联合血液净化治疗);分别于患者住院时、72 h及入院1周时记录APACHEⅡ评分和SOFA评分、氧合指数、乳酸水平、WBC、PCT、C反应蛋白及白介素-10、白介素-6及肿瘤坏死因子-a等炎性介质的变化情况,同时对3组患者的治疗效果及病死率进行比较。结果 CRRT组及乌司他丁联合CRRT组患者的血流动力学指标及各项炎症介质指标的恢复情况明显优于常规治疗组(P<0.05),而CRRT组及乌司他丁联合CRRT组在入院72 h及1周时患者血流动力学参数及炎症介质比较联合治疗组优于单纯应用CRRT治疗组(P<0.05)。在治疗1周后,CRRT组及联合治疗组病死率明显优于常规治疗组(P<0.05),而CRRT组和联合治疗组比较没有统计学意义(P<0.05)。结论 乌司他丁联合CRRT明显改善感染性休克患者的血流动力学,改善患者组织的低灌注,改善氧合指数,保持患者内环境稳定,稳定血压,同时降低了感染性休克的病死率,乌司他丁联合CRRT是治疗感染性休克的有效方法,其机制可能与清除炎性介质及抑制炎性介质的产生有关。更多还原

【Abstract】 Objective To assess the application of ulinastatin combined with continuous renal replacement therapy(CRRT) for patients with infectious shock.Methods A total of 60 infectious shock patients who were admitted into our hospital were included and informed consent was signed.They were randomized divided into the following groups:Group A(routine treatment),Group B(blood purification in addition to routine treatment) and Group C(ulinastatin and blood purification in addition to routine treatment).Their APACHII and SOFA scores were record and the changes in oxygenation index,lactic acid,WBC,PCT,CRP,IL-10,IL-6 and TNF-a were measured immediately,72 h and 1 week after hospitalization.The three groups were compared for therapeutic efficacy and mortality.Results Groups B and C showed remarkably improved hemodynamic and inflammatory mediator indices in comparison with Group A(P <0.05).The above indices were better in Group C than Group B 72 h and 1 week after hospitalization(P <0.05).After one-week treatment,lower mortalities were reported in Groups B and C than Group A(P <0.05),but no statistical difference was found between Groups B and C(P>0.05).Conclusions Ulinastatin combined with CRRT can result in significantly improved hemodynamic changes in patients with infectious shock,relieve hypoperfusion within the tissues,improve oxygenation index,and maintain internal environment and blood pressure stable and reduce the mortality caused by infectious shock.The combined therapy is effective to treat infectious shock,which may be related with its inhibitory effects on inflammatory mediators.更多还原