乌司他丁对脓毒性休克病人肺毛细血管通透性和复苏效果的影响

目的研究乌司他丁对脓毒性休克病人肺毛细血管通透性和复苏效果的影响,为临床诊疗提供依据。方法 收集2014年3月到2017年3月黄冈市中心医院收治的脓毒性休克病人70例的临床资料,根据是否应用乌司他丁将病人分为研究组(n=36例)和对照组(n=34例),比较两组血管外肺水指数(PVPI)、肺血管通透性指数(EVLWI)、心输出量(CI)、中心静脉压(CVP)、外周血管阻力指数(SVRI)、氧合作用、乳酸、晶体液体总量、胶体液体总量、清蛋白及血管活性药物使用评分情况。结果 经过治疗后；对照组的PVPI从(0.63±0.03)降低为(0.52±0.02),研究组的PVPI从(0.62±0.03)降低为(0.43±0.04);对照组的EVLWI从(12.02±3.54)mL/kg升高为(18.93±3.17)mL/kg,研究组的PVPI从(11.74±2.31)mL/kg降低为(9.43±1.09)mL/kg,研究组PVPI、EVLWI改善优于对照组(t=11.797,16.957,均P=0.000),研究组胶体液体总量和清蛋白用量低于对照组(1 556.71±12.10)mL 比(794.20±11.31)mL,(67.61±3.81)g/L 比(30.51±5.82)g/L],差异有统计学意义(t=272.521,31.356,均P=0.000),经过治疗后,对照组的氧合作用从(1.02±0.04)升高为(1.35±0.19),研究组的氧合作用从(1.01±0.02)降低为(0.53±0.02),对照组的乳酸从(7.48±1.13)mmol/L降低为(3.65±1.23)mmol/L,研究组的PVPI从(7.89±1.42)mmol/L降低为(2.43±1.04)mmol/L,研究组氧合作用、乳酸改善优于对照组(t=25.755,4.490,均P=0.000)。结论 乌司他丁治疗脓毒性休克病人效果较好,能改善肺毛细血管通透性,降低复苏所需胶体液体和清蛋白总量,提高复苏效果。

Effects of Ulinastatin on pulmonary capillary permeability and resuscitation in patients with septic shock

Objective To study the effects of Ulinastatin on pulmonary capillary permeability and resuscitation in patients with septic shock,and to provide the basis for clinical diagnosis and treatment.Methods Clinical data of 70 patients with septic shock admitted to Huanggang Central Hospital from March 2014 to March 2017 were collected.The patients were assigned into study group (n=36) and control group (n=34) according to whether Ulinastatin was used or not.The extravascular lung water index (EVLWI),pulmonary vascular permeability index (PVPI),cardiac output (CI),central venous pressure (CVP),systemic vascular resistance index (SVRI),oxygenation,lactic acid,total amount of liquid crystal and colloid fluid volume,albumin and vascular active drug use score of two groups were compared.Results After treatment,the PVPI of the control group decreased from (0.63±0.03) to (0.52±0.02),and the PVPI of the study group decreased from (0.62±0.03) to (0.43±0.04).The EVLWI of the control group increased from (12.02±3.54) mL/kg to (18.93±3.17) mL/kg,and the EVLWI of the study group decreased from (11.74±2.31) mL/kg to (9.43±1.09) mL/kg.The improvement of PVPI and EVLWI in the study group was better than that in the control group (t=11.797,6.957,all P=0.000).The total amount of colloidal fluid and albumin in the study group were lower than those in the control group (1 556.71±12.10) mL vs. (794.20±11.31) mL,(67.61±3.81) g/L vs. (30.51±5.82) g/L],and the difference was statistically significant (t=272.521,1.356,all P=0.000).After treatment,the oxygenation of the control group increased from (1.02±0.04) to (1.35±0.19),and the oxygenation of the study group decreased from (1.01±0.02) to (0.53±0.02).The lactic acid of the control group decreased from (7.48±1.13) mmol/L to (3.65±1.23) mmol/L,and the PVPI of the study group decreased from (7.89±1.42) mmol/L to (2.43±1.04) mmol/L.The oxygenation and lactic acid improvement of the study group were better than the control group (t=25.755,4.490,all P=0.000).Conclusion Ulinastatin in treatment of septic shock has better results.It can improve the pulmonary capillary permeability,reduce the total amount of colloidal liquid and albumin,and improve the recovery effect.