乌司他丁对脓毒症患者肾功能及凝血功能的影响

目的:观察乌司他丁对脓毒症患者的肾功能及凝血功能的影响和治疗效果。方法:选择2010年5月至2014年1月本科符合脓毒症诊断标准的109例患者,按就诊先后顺序随机分为治疗组和对照组,两组患者均按《2008年国际严重脓毒血症和感染性休克治疗指南》治疗,其中在治疗组中加用乌司他丁。两组患者于治疗前及治疗后第7天分别检测活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、纤维蛋白原(fibrinogen,FIB)、血小板(platelet,PLT)、凝血酶原时间(prothrornbin time,PT),同时分别于1、3、5及7 d检测尿素氮(blood urea nitrogen,BUN)、肌酐(crea,Cr)、血清胱抑素C(cystatin,Cys-C)及尿N-乙酰氨基葡萄糖苷酶(urine N-acetyl-glucosaminid,NAG),对两组患者发生肾损害和需要连续肾替代治疗情况连续观察7 d,并记录机械通气时间、ICU住院时间、30 d生存率。结果:治疗组患者FIB及PLT均明显升高,APTT和PT均显著缩短,与对照组比较,差异有统计学意义(P<0.05);治疗组患者血Cr、第3天血BUN、Cys-C及NAG下降(P<0.05),而第5、7天时血BUN无显著下降(P<0.05),总体发生肾功能损害降低(P<0.05),同时治疗组患者机械通气时间及ICU住院时间与对照组相比明显缩短,且近期生存率较好(P<0.05)。结论:乌司他丁可减轻脓毒症患者的肾功能损害,改善脓毒症患者的凝血功能,减少住院时间,改善预后。

The effects of ulinastatin on kidney function and coagulation function of patients with severe sepsis

Objective:To investigate the effects of ulinastatin against kidney function and coagulation function in patients with sepsis.Methods:106 patients diagnosed as sepsis were divided into treatment group and control group.All patients were treated ac-cording to the guidline of rescuing severe septic shock,the treatment group received ulinastatin especially.The PLT,PT,APTT,FIB were examined before and after treatment;BUN,Cre,Cys-C and NAG were examined in 1 ,3,5 and 7 days.Kidney functions injury, CRRT rate,duration of mechanical ventilation,length of stay in ICU,and survival rate in 30 days was examined.Results:The PLT, FIB of treatment group were higher,and PT,APTT were lower than control group(P <0.05).Cre,BUN,Cys-C and NAG in 3 days were decreased(P <0.05),but BUN didn't decreased significantly in 5 and 7 days (P <0.05),while the rate of kidney functions in-jury decreased (P <0.05).The duration of mechanical ventilation,length of stay in ICU were shorter than control group,and survival rate in 30 days was longer than control group(P <0.05).Conclusion:The ulinastatin is better in improving coagulation function,miti-gating kidney injury,reducing the hospital stay,and improves prognosis of patients with sepsis.