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目的:探讨乌司他丁对感染性休克患者血清白细胞介素-6(IL-6)、白细胞介素-10(IL-10)和降钙素原(PCT)水平的影响及疗效。方法:64例感染性休克患者随机分为观察组和对照组各32例。两组患者均予以补液扩容、抗感染及维持水电解质酸碱平衡等治疗,必要时行机械通气及使用血管活性药物治疗。观察组在此基础上加用乌司他丁20万U加入0.9%氯化钠注射液100 ml中静滴,q12h,对照组予等量0.9%氯化钠注射液静脉,两组疗程均为1周。比较两组患者治疗前后血清IL-6、IL-10和PCT水平的变化,观察治疗后多器官功能障碍综合征(MODS)的发生率、病死率及药物不良反应。结果:治疗1周后,两组患者血清IL-6和PCT水平均较治疗前下降,血清IL-10水平均较治疗前上升(P<0.05或0.01),且观察组下降或上升值明显大于对照组(P<0.05)。观察组患者MODS发生率明显低于对照组(P<0.05)。两组患者病死率和药物不良反应发生率比较差异无统计学意义(P>0.05),治疗期间未发生严重药物不良反应。结论:基础治疗同时加用乌司他丁治疗感染性休克疗效显著,安全性较佳,能明显减少MODS发生率,其治疗效果与抑制血清IL-6和PCT释放和促进IL-10释放密切相关。
Objective: To investigate the effect of ulinastatin on serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10) and procalcitonin (PCT) in patients with septic shock. Methods: Sixty-four patients with septic shock were randomly divided into observation group and control group with 32 cases each. Two groups of patients were rehydration expansion, anti-infective and maintain the balance of water and electrolyte acid-base treatment, if necessary, mechanical ventilation and vasoactive drug treatment. On the basis of the observation group, Ulinastatin 200 000 U was added to 100 ml of 0.9% sodium chloride injection for intravenous infusion for q12h, and the control group was given 0.9% sodium chloride injection intravenously in equal volume 1 week. The levels of IL-6, IL-10 and PCT in the two groups were compared before and after treatment. The incidence of multiple organ dysfunction syndrome (MODS), mortality and adverse reactions were observed after treatment. Results: After 1 week of treatment, serum IL-6 and PCT levels in both groups decreased compared with those before treatment, and serum IL-10 levels increased compared with before treatment (P <0.05 or 0.01), and the decrease or increase in observation group was significantly greater than Control group (P <0.05). The incidence of MODS in observation group was significantly lower than that in control group (P <0.05). No significant difference was found between the two groups in the incidence of CFR and ADR (P> 0.05). No serious adverse drug reactions occurred during the treatment. Conclusion: The combination of basic treatment and ulinastatin in treating septic shock is effective and safe, and can significantly reduce the incidence of MODS. The therapeutic effect is closely related to the inhibition of serum IL-6 and PCT release and the promotion of IL-10 release .