乌司他丁治疗创伤失血性休克全身炎症反应的临床研究

目的探讨创伤失血性休克患者血清肿瘤坏死因子-α（TNF-α）和白细胞介素-6（IL-6）的变化以及乌司他丁的治疗作用。方法将54例创伤失血性休克患者随机分为常规抗休克治疗组（Z组：26例）和乌司他丁（Ulinastatin,UTI）治疗组（U组：28例）,U组在常规抗休克治疗基础上加用乌司他丁10万U静注,1次/8h,连续用药7d。观察比较两组患者在入院时ISS评分、APACHEⅢ评分、总的住院时间、住ICU治疗时间、MODS发生率、死亡率,以及两组患者血清肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）在治疗前（发生创伤1h内）以及治疗后第1d、3d、5d、7d各时间点血中的含量。结果 U组和Z组患者的性别构成比、年龄、入院时ISS评分、初始APACHEⅢ评分、总的住院时间、住ICU治疗时间、死亡率的比较差异无统计学意义（P〉0.05）;U组MODS发生率和治疗第3d的APACHEⅢ评分较Z组明显降低,差异有统计学意义（P〈0.05）。U组与Z组患者在治疗第1d、3d、5d、7d各时间点检测血INF-α、IL-6浓度比较,U组较Z组明显下降,差异有统计学意义（P〈0.05或P〈0.01）。结论创伤失血性休克患者的血TNF-α、IL-6是升高的,乌司他丁可降低这些细胞因子的水平;给予乌司他丁的干预治疗对创伤失血性休克全身炎症反应综合征有积极作用,从而起到保护器官的作用。

Effect of ulinastatin on patients with systemic inflammatory response after traumatic hemorrhagic shock

Objective To investigate changes of tumor necrosis factor-or （TNF-ct） and interleukin-6 （IL-6） in patients with traumatic hemorrhagic shock and the therapeutic effect of ulinastatin （UTI）. Methods The 54 patients with traumatic hemorrhagic shock were randomly divided into two groups：Group Z consisted of 26 patients treated with conventional anti-shock treatment;and Group U consisted of 28 patients treated with ulinastatin at dose of 10,000 units once per 8 hours for 7 continuous days and conventional anti-shock treatment.The ISS score and APACHE HI score upon patients＇ admission, their total length of stay in hospital and ICU, the incidence of MODS, mortality, the levels of TNF-a and IL,-6 in their blood before treatment （within 1 hour after the shock）,and on the 1st day,3rd day,5th day and 7th day after treatment were observed and compared. Results The differences between the two groups＇ sex ratios,ages,ISS scores and APACHE HI scores upon admission,total lengths of stay in hospital,the lengths of stay in ICU and mortality did not show statistically significant （P〉 0.05）; the incidence of MODS and the APACHEⅢ score on the 3rd day after treatment of Group U were significantly lower than those of Group Z showing statistically significant differences （P〈 0.05）. The levlls of TNF-a and IL-6 in patients＇ blood of Group U＇ on the 1st day,3rd day,5th day and 7th day after treatment were more greatly lowered than Group Z and the differences are statistically significant. Conclusions The levels of TNF-a and IL-6 in patients with traumatic hemorrhagic shock would raise. Intervention therapy with the use of ulinastatin is effective for treatment of systemic inflammatory response syndrome （SIRS） in patients with traumatic hemorrhagic shock, thus protecting their organs.