乌司他丁联合连续性血液净化治疗重症脓毒症临床研究

目的：研究连续性血液净化联合乌司他丁对重症脓毒症患者炎症反应的影响及其临床疗效。方法：70例重症脓毒症患者随机分为对照组（n=22例）、CBP组（n=23例）和CBP＋乌司他丁组（n=25例），其中对照组采用经典治疗方案，CBP组在此基础上加用连续性血液净化，CBP＋乌司他丁组在CBP组基础上加用乌司他丁治疗。观察比较患者病情发展，分别于治疗前后进行血液生化指标、凝血功能检测和动脉血气分析，ELISA法检测血清CRP水平。结果：①与对照组和CBP组相比，CBP＋鸟司他丁纽患者病死率、ICU住院时间、MODS发生率均明显下降（P〈0．05）。②经过治疗，CBP＋乌司他丁组患者APACHEⅡ评分降至15．46±3．96，与对照组（18．06±4．25）和CBP组（17．14±5．55）比较差异有统计学意义（P〈0．05）。③治疗后，患者BUN、HR降低程度依次为CBP＋乌司他丁组〉CBP组〉对照组，组问比较差异有显著性（P〈0．05），而治疗前后PH值、HCO3-、MAP比较差并不明显（P〉0．05）。④CBP＋乌司他丁纽血清CRP含量下降，WBC数量减少，其变化程度明显大于CBP组和对照组（P〈0．05）。⑤对照组、CBP组和CBP＋乌司他丁组患者PT、TT和APTT时间延长，血小板数量下降，其中CBP＋鸟司他丁组PT、APTT时间短于CBP组和对照组（P〈0．05）。结论：连续性血液净化联合乌司他丁可有效抑制脓毒症患者炎症反应，缓解病情，改善患者预后。

Clinical study on treatment of continuous blood purification combined with Ulinastatin for patients with severe sepsis

Objective： To investigate the effect of continuous blood purification combined Ulinastatin on inflammation of patients with severe sepsis, as well as the clinical outcomes. Methods： 70 cases with severe sepsis subsequently divided into control group （n=22）, CBP group （n=23） and CBP＋ Ulinastatin group （n=25）. The control group received classical treatment, the CBP group was added with continuous blood purification, and the CBP＋ Ulinastatin group with Ulinastatin. The development of disease was observed, and the blood biochemical parameters, coagulation index and arterial blood gas analyses were evaluated before and after treatment. ELISA was used to quantify the serum concentration of CRP. Results： ①Compared with control and CBP group, the case-fatality rate, length of ICU stay and rate of MODS significantly decreased in CBP＋ Ulinastatin group （P〈0.05）. ②After treatment, the APACHE II score CBP＋Ulinastatin group fell to 15.46± 3.96, significantly lower than control group （18.06±4.25） and CBP group （17.14±5.55） （P〈0.05）. ③The levels of BUN and HR was lowest in CBP＋ Ulinastatin group, followed successively by CBP and control group. （P〈0.05） But no difference was found in PH, HCO3- and MAP among groups （P〉0.05）.④ARcr treaUnent, the levels of serum CRP and WBC significantly decreased, especially in CBP＋Ulinastatin group （P〈0.05）. ⑤PT, TT and APTT increased in all patients, and PLT decreased. The PT and APTT was shorter in CBP＋Ulinastatin group than control and CBP group （P〈0.03）. Conclusion： Combination of continuous blood purification and Ulinastatin for the treatment of severe sepsis can inhibit inflammatory response, reduce the severity of the sepsis, and improve prognosis.