乌司他丁联合氢化可的松治疗重症脓毒血症休克的疗效及对血清因子的影响

目的:探讨乌司他丁联合氢化可的松治疗重症脓毒血症休克的疗效及对血清因子的影响。 方法:选择2015年12月至2017年12月我院接诊的87例重症脓毒症继发休克患者作为研究对象,通过随机数表法分为对照组43例,试验组44例。对照组给予常规治疗,试验组在对照组基础上,联合乌司他丁20万U加入5%葡萄糖溶液250 mL中静脉滴注+200 mg氢化可的松加入5%葡萄糖溶液250 mL中静脉滴注,1次/d,均连续治疗2周。比较2组临床疗效、实验室指标、血清降钙素原（PCT）、IL-6、IL-10、机械通气时间、住院时间、药物不良反应及28 d死亡率。 结果:治疗后,试验组和对照组临床疗效总有效率分别为86.36%（38/44）、67.44%（29/43）,差异具有统计学意义（P＜0.05）;治疗后,试验组和对照组收缩压（SBP）分别为（85.82±6.25）、（78.80±9.26） mmHg,C反应蛋白（CRP）分别为（34.78±4.79）、（46.76±5.93） mg/L,白细胞计数（WBC）分别为（7.85±2.02）、（12.49±2.14）×109/L,PCT分别为（1.50±0.22）、（2.70±0.46） ng/mL,IL-6分别为（59.13±12.73）、（82.32±18.40） pg/mL,IL-10分别为（10.04±1.25）、（14.41±1.88） pg/mL,急性生理和慢性健康评分（APACHEⅡ）分别为（10.30±1.41）、（14.51±1.68）分,差异具有统计学意义（P＜0.05）;试验组机械通气时间和住院时间分别为（10.02±1.65）、（16.00±1.36） d,对照组分别为（17.58±2.54）、（24.00±1.69） d,差异具有统计学意义（P＜0.05）;治疗期间,2组均未出现严重不良反应,试验组出现1例注射部位皮疹,2组不良反应发生率差异无统计学意义（P＞0.05）;试验组和对照组28 d死亡率为4.55%（2/44）、20.93%（9/43）,差异具有统计学意义（P＜0.05）。 结论:乌司他丁联合氢化可的松用于重症脓毒症继发休克患者中效果显著,可有效缓解病情、降低死亡率,且药物不良反应少,安全性高。

Curative efficacy of ulinastatin combined with hydrocortisone in treatment of severe sepsis secondary shock and effects on serum factor levels

AIM: To study curative efficacy of ulinastatin combined with hydrocortisone in treatment of severe sepsis secondary shock and effects on serum factor levels. METHODS: 87 patients of severe sepsis secondary shock who received therapy from December 2015 to December 2017 in our hospital were selected as research objects. According to random number table, those patients were divided into the 43 cases of the control group and the 44 cases of the treatment group. The control group was treated with routine treatment, on the basis of the control group, the treatment group combined with intravenous drip of ulinastatin 200 thousand U into the 5% glucose solution 250 mL+intravenous infusion of 200 mg hydrocortisone into 5% glucose solution 250 mL, 1 times/d, they were continuous treatment for 2 weeks. The clinical efficacy, laboratory indexes, serum procalcitonin (PCT), IL-6, IL-10, mechanical ventilation time, hospitalization time, adverse drug reaction and 28 d mortality were compared between the 2 groups. RESULTS:After treatment, the total effective rate of the treatment group and the control group were 86.36%（38/44）and 67.44%（29/43）respectively, there was significant differences in comparison (P＜0.05). After treatment, the systolic pressure (SBP) of the treatment group and the control group were（85.82±6.25） and （78.80±9.26）mmHg, respectively; the C reactive protein (CRP) were (34.78±4.79) and (46.76±5.93) mg/L, respectively; the white blood cell count (WBC) were (7.85±2.02) and (12.49±2.14)×109/L, respectively; the PCT were (1.50±0.22) and (2.70±0.46) ng/mL, respectively; the IL-6 were（59.13±12.73）and（82.32±18.40）pg/mL, respectively; the IL-10 were （10.04±1.25）and （14.41±1.88）pg/mL respectively; the acute physiology and chronic health evaluation (APACHEⅡ) were（10.30±1.41）and（14.51±1.68）score, there were significant differences in comparison (P＜0.05). The mechanical ventilation time and hospitalization time in the treatment group were（10.02±1.65）d and（16.00±1.36）d, respectively, those in the control group were （17.58±2.54）d and（24.00±1.69）d, respectively; there were significant differences in comparison (P＜0.05). During the treatment period, there were no serious adverse reactions in the 2 groups, there were 1 cases of rash in the treatment group, and there was no significant difference in the incidence of adverse reactions between the 2 groups (P＞0.05). The 28 d mortality in the treatment group and the control group was 4.55%（2/44）and 20.93% (9/43), respectively, there was significant differences in comparison (P＜0.05). CONCLUSION:Ulinastatin combined with hydrocortisone is well for severe sepsis secondary shock, which can effectively relieve the disease, reduce the mortality, and have less adverse drug reactions and high safety.