【摘要】 目的:探讨乌司他丁联合亚胺培南治疗脓毒症致急性呼吸窘迫综合征患者的疗效,以及对血小板-白细胞聚集体水平和心功能的影响。方法:选取2015年9月至2019年6月在海南省第三人民医院ICU住院治疗的脓毒症致急性呼吸窘迫综合征患者130例,采用随机数字表法将患者分为对照组和研究组,每组65例。研究组患者给予乌司他丁联合亚胺培南治疗,对照组患者仅给予乌司他丁治疗。观察两组患者的白细胞计数（WBC）、C反应蛋白（CRP）、降钙素原（PCT）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）及氧合指数（PaO₂/FiO₂）水平,采用急性生理与慢性健康评分（acute physiology and chronic health evaluation,APACHEⅡ）系统对两组患者治疗前后的健康状况进行评估,比较两组患者血小板-白细胞聚集体共存情况、心功能变化、撤机成功率、ICU病死率及ICU住院时间的差异。结果:与治疗前比较,两组患者治疗后外周血WBC、血清CRP、PCT及APACHEⅡ评分均明显降低,且研究组患者明显更低,差异均有统计学意义（P <0.05）;与治疗前比较,两组患者治疗后PaO₂、PaO₂/FiO₂均明显升高,而PaCO₂明显降低,且研究组患者变化幅度更大,差异均有统计学意义（P<0.05）。治疗后,两组患者血小板-中性粒细胞聚集体和血小板-单核细胞聚集体水平均较治疗前明显降低,且研究组患者明显更低,差异均有统计学意义（P<0.05）。治疗后,两组患者左心室舒张末期内径较治疗前明显降低,左心室射血分数明显升高,且研究组患者变化幅度更大,差异均有统计学意义（P<0.05）。研究组患者的ICU死亡率明显低于对照组,ICU住院时间、撤机时间明显短于对照组,撤机成功率明显高于对照组,差异均有统计学意义（P<0.05）。结论:乌司他丁联合亚胺培南治疗脓毒症致急性呼吸窘迫综合征的临床效果较好。更多还原

【Abstract】 OBJECTIVE: To probe into the efficacy of ulinastatin combined with imipenem in the treatment of acute respiratory distress syndrome induced by sepsis and its effect on leukocyte-platelet aggregate level and cardiac function. METHODS: Totally 130 patients with acute respiratory distress syndrome induced by sepsis admitted into ICU of the Third People’s Hospital of Hainan Province from Sept. 2015 to Jun. 2019 were selected and divided into control group and research group via the random number table,with 65 cases in each group. The research group was given ulinastatin combined with imipenem,while the control group was treated with ulinastatin alone. The white blood cell （WBC） count,C-reactive protein （CRP）,arterial partial pressure of oxygen （PaO₂）,partial pressure of carbon dioxide in artery （PaCO₂） and oxygenation index （PaO₂/FiO₂） of both groups were observed,acute physiology and chronic health evaluation （APACHEⅡ） system was adopted to grade the health condition of both groups before and after treatment,differences in leukocyte-platelet aggregation,changes of cardiac function,success rate of ventilator withdrawal,fatality rate and hospital stay between two groups were compared. RESULTS: Compared with before treatment,the WBC count in peripheral blood,serum CRP,PCT and APACHE Ⅱ scores of both groups were significantly decreased after treatment,and those of the research group were significantly lower,with statistically significant differences （P < 0. 05）; compared with before treatment,the PaO₂ and PaO₂/FiO₂ levels of both groups increased significantly,while the PaCO₂ level decreased significantly,and the amplitude of variation in research group was larger,with statistically significant differences （P<0. 05）. After treatment,the platelet-neutrophil aggregation and leukocyte-platelet aggregation levels of both groups decreased significantly,and those of the research group were significantly lower,with statistically significant differences （P < 0. 05）. After treatment,the LVEDD levels of both groups were significantly lower than those of before treatment,while the LVEF levels increased significantly,and the amplitude of variation in research group was larger,with statistically significant differences （P < 0. 05）. The ICU fatality rate of research group was significantly lower than that of the control group,the ICU hospital stay and ventilator withdrawal time were significantly shorter than those of the control group,and the success rate of ventilator withdrawal was significantly higher than that of the control group, with statistically significant differences （P < 0. 05）.CONCLUSIONS: The efficacy of ulinastatin combined with imipenem in the treatment of acute respiratory distress syndrome induced by sepsis is remarkable.更多还原