周丽++徐洪山++王齐国+++赵丹++张程

[摘要] 目的 探討乌司他丁联合常规集束化干预对重症脓毒症患者炎症因子变化及全身各器官功能的影响。 方法 选择2012年1月～2015年12月新疆维吾尔自治区中医医院重症监护室收治的重症脓毒症患者80例，按照随机数字法分为观察组与对照组，每组各40例，在集束化干预基础上，观察组应用乌司他丁注射液，对照组行空白对照。比较干预治疗前后两组血清内毒素水平、静息能量消耗、非蛋白呼吸商情况、炎症相关因子、心功能、肝功能、肾功能相关指标以及APACHEⅡ评分变化情况。 结果 干预治疗后观察组血清内毒素水平、静息能量消耗、非蛋白呼吸商水平、白介素-6（IL-6）、肿瘤坏死因子α（TNF-α）、白介素-1（IL-1）、高敏C反应蛋白（hs-CRP）、血栓素B2（TXB2）、丙氨酸转氨酶（ALT）、谷草转氨酶（AST）、总胆红素（TBil）、血尿素氮（BUN）、肌氨酸酐（Cr）、肺毛细血管楔压（PCWP）水平均低于对照组（P < 0.05），干预治疗后观察组肾小球滤过率（GFR）、左心室射血分数（LVEF）、心排血指数（CI）均高于对照组（P < 0.05），干预治疗后观察组APACHEⅡ评分显著低于对照组（P < 0.05）。 结论 针对脓毒症患者使用乌司他丁治疗，能有效抑制机体炎性反应，降低内毒素水平，改善心肝肾等重要脏器功能，提高患者预后。

[关键词] 乌司他丁；脓毒症；炎症因子；器官功能；集束化治疗

[中图分类号] R631 [文献标识码] A [文章编号] 1673-7210（2017）04（b）-0119-05

[Abstract] Objective To investigate the effects of ulinastatin combined with conventional cluster intervention on the changes of inflammatory factors and systemic organ function in patients with severe sepsis. Methods From January 2012 to December 2015， in ICU of Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region， 80 patients with severe sepsis were selected， according to random number table， they were divided into observation group and control group， with 40 cases in each group. On the basis of cluster intervention， Ulinastatin Injection was used in observation group， and control group was as blank control experiment. The serum endotoxin levels， resting energy expenditure， non-protein respiratory quotient， inflammatory related factors， cardiac function， liver function， renal function related indicators and APACHEⅡ score changes of the two groups before and after intervention treatment were compared. Results After the intervention treatment， the serum endotoxin level， resting energy expenditure， non-protein respiratory quotient level， IL-6， TNF-α，IL-1， hs-CRP， TXB2， ALT， AST， Tbil， BUN， Cr and PCWP levels of the observation group were lower than those of the control group （P < 0.05）. After the intervention treatment， the GFR， LVEF and CI of the observation group were higher than those of control group （P < 0.05）， and the APACHE Ⅱ scores of observation group were significantly lower than those of the control group （P < 0.05）. Conclusion Ulinastatin in the treatment of patients with sepsis can effectively inhibit the inflammatory reaction， reduce endotoxin levels， improve the heart， liver， kidney and other important organ function， and improve the prognosis of patients.

[Key words] Ulinastatin； Sepsis； Inflammatory factor； Organ function； Cluster treatment

脓毒症一旦发生将引起机体炎性反应的瀑布效应，其会迅速导致机体免疫系统、凝血系统、心血管系统、肝肾功能等多方面受损或功能障碍，其也是导致多器官功能衰竭的主要原因[1-5]。临床上如何有效的抑制机体炎性反应，进而恢复患者机体各器官功能是脓毒症治疗的重点亦是治疗难点。脓毒症的治疗有着“金时银天”的说法，其救治时间就是生命[6]，集束化干预能有效综合各种治疗手段的优点，提高救治效果，是提高脓毒症患者生存率的关键[7]。……