乌司他丁并持续血液净化治疗多器官功能障碍综合征的研究

目的 研究乌司他丁联合床旁高流量持续血液净化治疗重症患者多器官功能障碍综合征的作用,探讨其对系统性炎症反应综合征(SIRS)、脓毒血症(sepsis)、急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)的作用机制.方法 122例重症患者急性生理和慢性健康评分(APACHE Ⅱ)≥15分,随机分为:常规治疗加乌司他丁组(乌司他丁组,35例);常规治疗力加床旁持续高流量血液净化组(净化组,31例);乌司他丁联合床旁高流量持续血液净化组(联合组,30例);常规治疗组(对照组,26例);检测治疗前及治疗后第1、3、7天血浆高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6),同时监测血常规、肝.肾功能、凝血四项、动脉血气分析氧合指数、APACHEⅡ分值,比较各组MODS发生率.结果 ①治疗后第1、3、7天,乌司他丁组、净化组的血浆hs-CRP、IL-6水平较对照组叫显降低(P<0.05.P<0.01),联合组下降更显著,治疗前各组差异无统计学意义(P>0.05),第3、7天差异无统计学意义(P>0.05);②治疗后第1、3、7天,乌司他丁组、净化组,氧合指数Pa02/Fi02较对照组明显改善(P<0.05,P<0.01),联合组改善更显著,同时丙氨酸氨基转移酶(ALF)、肌酐(Cr)低于对照组,治疗前无明显差别(P>0.05);③治疗后第1、3、7天,乌司他丁组、净化组的APACHEⅡ较对照组显著降低(P<0.05,P<0.01),联合组改善更显著,同时器官衰竭率均低于对照组(P<0.05～0.01).结论 乌司他丁有抑制hs-CRP、IL-6等炎性细胞因子过度释放的作用持续床旁高流量血滤可以清除炎性介质,两者联合效果更佳;可以有效阻断SIRS、ARDS发展和MODS形成,保护肺、肝、肾、脑等器官功能,降低病死率.

A clinical study of ulinastatin combining with continuous blood purification in the treatment of patients with multiple organ dysfunction syndrome

Objective To observe the clinical efficacy of ulinastatin(UT) conjoined to high flow continuous blood purification( CBP) in the critical patients with multiple organ dysfunction syndrome(MODS). To evaluate the therapeutic potential of UT and CBP in systemic inflammatory response syndrome (SIRS) , severe sepsis( SS) , acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Method A total of 122 cases of emergency and critical patients with a score of more than 15 counted up from APACHE H (acute physiology and chronic health evaluation 11 ) were randomly divided into Ulinastatin treatment group (UT group, n = 35) .continuous blood pu-rification(CBP group, n = 31),UT plus CBP (combine group, n = 30) and routine treatment group (control group, n =26). Routine treatment was given to patients of all groups, and patients of UT group had Ulinastatin 0.4 MIU given intravenously every 8 hours for 7 days in addition. Patients of CBP group were managed with continuous blood purification round the clock for 7 days and those of combine group were treated with UT plus CBP for 7 days.The efficacy of the treatment in four groups was assessed,and serum high sensivity reactive protein(hs-CRP) and IL-6 levels were measured on admission and comparison was made between values of biomarkers taken before and 1 d,3 d,and 7 d after treatment in four groups. The changes in WBCs,arterial gas analysis and the oxygena-tion index PaO2/FiO2 were checked, and at the same time, the APACHE II values and the incidence of MODS were compared within four groups. Results (1)One, three and seven days after treatment the plasma hs-CRP and IL-6 levels in UT and CBP groups were reduced significantly more than those in control group ( P < 0. 05), and in combine groups those were more dramatically lowered ( P < 0.05, P < 0.01). Before treatment there was no significance diffience in those values between groups, and there was on diffience in those values between 3 rd day and 7 th day after treatment ( P > 0.05). (2) The 1 st,3 rd and 7 th day after treatment the arterial gas PaO2/FiO2 index in UT and CBP groups was improved more than that in control group ( P < 0.05) , and it in combine group was most significant improved (P < 0.05,P < 0.01). The ALT and creatinine were lower than those in control group ( P < 0.05), and there were no significant differences in ALT and creatinine between groups before treatment (P > 0.05). (3) The 1 st,3 rd and 7th day afer treatment,the APACHE II values in UT and CBP groups were decreased more than those in control group ( P < 0. 05) , and therefore, the incidence of MODS was lower ( P < 0.05). Conclusions Ulinastatin could significantly inhibit the production of inflammatory cytokines and CBP could effectively eliminate inflammatory factors from blood, and the combination of these two approaches produce a more effective therapeutic potential for preventing MODS development.