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目的观察乌司他丁注射剂联合血液净化术对重症感染性患者的炎症介质及氧合指数的影响。方法将100例重症感染性休克患者随机分为对照组50例和试验组50例。对照组进行常规治疗;试验组在对照组的基础上加用乌司他丁20万U+0.9%NaCl 20 mL+血液净化术治疗24 h,治疗持续3 d。比较2组患者的临床疗效、肿瘤坏死因子-α、白细胞介素-8、白细胞介素-6、氧合指数(PaO_2/FiO_2)及药物不良反应的发生情况。结果治疗后,试验组患者总有效率为90.00%(45例/50例),对照组为52.00%(26例/50例),差异有统计学意义(P<0.05)。治疗后,试验组的肿瘤坏死因子-α、白细胞介素-8、白细胞介素-6分别为(8.39±3.14),(4.21±1.14),(4.95±1.77)μg·L~(-1),对照组分别为(17.28±2.91),(9.07±1.04),(10.99±1.32)μg·L~(-1),差异均有统计学意义(均P<0.05)。治疗后1,12,24,72 h,试验组氧合指数分别为141.21±16.92,187.82±21.51,203.12±26.30,284.21±45.12,对照组分别为135.31±19.23,149.30±20.60,178.72±29.21,199.60±40.52,差异均有统计学意义(均P<0.05)。2组患者治疗期间均未发生药物不良反应。结论乌司他丁联合血液净化术对重症感染性休克患者的疗效更加显著,明显降低炎症介质,改善患者的氧合指数。
Objective To observe the effects of ulinastatin injection combined with blood purification on inflammatory mediators and oxygenation index in critically ill patients. Methods One hundred patients with severe septic shock were randomly divided into control group (50 cases) and experimental group (50 cases). The control group was treated routinely. The experimental group was treated with 20 mg ulinastatin (20 U + 0.9% NaCl) + blood purification for 24 hours on the basis of the control group, and the treatment lasted for 3 days. The clinical efficacy, tumor necrosis factor-α, interleukin-8, interleukin-6, oxygenation index (PaO 2 / FiO 2) and adverse drug reactions were compared between the two groups. Results After treatment, the total effective rate was 90.00% (45 cases / 50 cases) in the test group and 52.00% (26 cases / 50 cases) in the control group. The difference was statistically significant (P <0.05). After treatment, the levels of tumor necrosis factor-α, interleukin-8 and interleukin-6 in the experimental group were (8.39 ± 3.14), (4.21 ± 1.14), (4.95 ± 1.77) μg · L -1, (17.28 ± 2.91), (9.07 ± 1.04) and (10.99 ± 1.32) μg · L -1, respectively (all P <0.05). The oxygenation index of the experimental group was respectively 141.21 ± 16.92, 187.82 ± 21.51, 203.12 ± 26.30 and 284.21 ± 45.12 at 1, 12, 24, and 72 h after treatment, the control group was 135.31 ± 19.23, 149.30 ± 20.60, 178.72 ± 29.21, 199.60 ± 40.52, the difference was statistically significant (all P <0.05). Two groups of patients during the treatment did not occur adverse drug reactions. Conclusion Ulinastatin combined with blood purification in patients with severe septic shock more significant effect, significantly reduce the inflammatory mediators and improve the oxygenation index of patients.