乌司他丁辅助高容量血液滤过对严重脓毒血症血清细胞黏附分子-1、胆碱酯酶和凝血功能的影响

发布时间：2018-01-11 12:09

本文关键词：乌司他丁辅助高容量血液滤过对严重脓毒血症血清细胞黏附分子-1、胆碱酯酶和凝血功能的影响　出处：《中国现代医学杂志》2016年11期 　论文类型：期刊论文

【摘要】：目的探讨乌司他丁辅助高容量血液滤过治疗严重脓毒血症的临床疗效,以及对患者血清细胞黏附分子-1(ICAM-1)、胆碱酯酶和凝血功能的影响。方法选取2012年1月-2014年12月在该院接受治疗的106例严重脓毒症患者作为研究对象,回顾性分析其临床资料,按治疗方案分为对照组(47例)和观察组(59例)。在常规治疗基础上,对照组给予高容量血液滤过治疗,观察组在对照组基础上给予乌司他丁辅助治疗。比较两组患者生理学与慢性健康状况评分(APACHEⅡ)、全身感染相关器官功能障碍评分(SOFA)、Marshall评分,28 d弥漫性血管内凝血(DIC)发生率、多功能器官障碍综合征(MODS)发生率、病死率、血清ICAM-1、胆碱酯酶和凝血功能指标。结果治疗7d后,与对照组比较,观察组APACHEⅡ、SOFA及Marshall评分降低(P0.05)。28 d时,对照组DIC发生率和MODS发生率分别为17.0%和23.4%,观察组的分别为3.4%和8.5%,与对照组比较,观察组DIC和MODS发生率降低,差异有统计学意义(P0.05)。观察组的病死率为15.3%,对照组为29.8%,组间比较差异无统计学意义(P0.05)。与对照组比较,观察组治疗后凝血酶原时间(PT)、激活部分凝血酶原时间(APTT)降低,纤维蛋白原(FIB)、血小板(PLT)升高,ICAM-1水平下降,胆碱酯酶水平升高,差异有统计学意义(P0.05)。结论乌司他丁辅助高容量血液滤过能够明显改善患者凝血功能,降低ICAM-1,提高胆碱酯酶水平,从而提高严重脓毒症的临床疗效,值得进一步研究。
[Abstract]:Objective to investigate the clinical effect of ulinastatin in aid of high volume hemofiltration on severe sepsis, and on serum cell adhesion molecules in patients with -1 (ICAM-1), effects of cholinesterase and coagulation function. 106 cases of severe sepsis patients methods from January 2012 -2014 year in December treated in our hospital as the research object, retrospective analysis the clinical data, according to the treatment plan, divided into control group (47 cases) and observation group (59 cases). On the basis of routine treatment, the control group was given the treatment of high volume hemofiltration, observation group in the control group were given Ulinastatin treatment. And chronic health evaluation (physiological studies were compared between the two groups APACHE II), systemic infection related organ dysfunction score (SOFA), Marshall score, 28 d of disseminated intravascular coagulation (DIC) incidence, multi organ dysfunction syndrome (MODS) incidence rate, mortality rate, serum ICAM-1, choline Esterase and blood coagulation indexes. Results after 7d treatment, compared with control group, the observation group of APACHE, SOFA and Marshall were lower (P0.05).28 D, control group DIC incidence rate and the incidence rate of MODS were 17% and 23.4%, the observation group were 3.4% and 8.5%, compared with the control group, the observation group DIC and MODS were significantly decreased, the difference was statistically significant (P0.05). The observation group the mortality rate was 15.3%, the control group was 29.8%, there was no significant difference between groups (P0.05). Compared with the control group, the observation group after treatment of prothrombin time (PT), activated partial thromboplastin time (APTT) decreased. Fibrinogen (FIB), platelet (PLT) increased, ICAM-1 level decreased, cholinesterase levels increased, the difference was statistically significant (P0.05). Conclusion ulinastatin for high volume hemofiltration can significantly improve the coagulation function of patients, reduce ICAM-1, improve the cholinesterase level to improve. The clinical efficacy of severe sepsis is worthy of further study.

【作者单位】：海南医学院附属医院重症医学科;
【分类号】：R459.7
【正文快照】： 严重脓毒血症是感染、创伤等导致的严重并发症,是一种全身炎症反应综合征,治疗难度大,如果不能得到及时有效治疗,病情进展可能出现弥漫性血管内凝血(disseminated intra-vascular coagulation,DIC)及多功能器官障碍综合征(multiple organ dys-function syndrome,MODS)等,严重

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