乌司他丁联合连续性血液净化对ICU脓毒症患者血清LAC、PCT、CRP水平及康复进程的影响

摘要

Objective To investigate the effect of ulinastatin and continuous blood purification on the serum levels of lactic acid (LAC), procalcitonin (PCT), C reactive protein (CRP), and rehabilitation in ICU patients with sepsis. Methods From January 2014 to May 2016, 68 patients with sepsis in ICU of our hospital were selected and divided into control group and study group according to different treatment plan, 34 cases in each group. The control group was treated with continuous blood purification, and the study group was treated with continuous blood purification combined with ulinastatin. The changes of serum levels of LAC, PCT, CRP,coagulation function related indexes [activated partial thromboplastin time (APTT), prothrombin time (PT), platelet count (PLT)], quality of life, and prognostic related indicators [multiple organ failure score (SOFA), acute physiology and chronic health score (APACHEII)] were compared between the two groups before and after treatment, and statistically analyzed ICU stay time, the mortality after follow-up of 1 year. Results The levels of serum LAC, PCT, CRP, and coagulation function related indexes (APTT, PT, PLT) of the two groups were not statistically significant before treatment (P>0.05); compared with the control group, the levels of serum LAC, PCT, CRP, APTT, and PT in the study group were lower, and the level of PLT was higher, with statistically significant differences (P<0.05). There were no statistically significant differences in terms of the scores of material life state, psychological, physical, and social function, SOFA score, APACHEII score between the two groups before treatment (P>0.05); compared with the control group, the scores of material life state, psychological, physical, and social function in the study group were higher, SOFA score and APACHEII score were lower, with statistically significant differences (P<0.05). ICU stay time of the study group was shorter than that of the control group [(10.75±2.43)d vs.(15.26±3.31)d], the mortality after follow-up of 1 year was lower than that of the control group (5.88％ vs.23.53％), with statistically significant differences (P<0.05). Conclusion Ulinastatin combined with continuous blood purification in ICU patients with sepsis can significantly reduce the serum levels of LAC, PCT, and CRP, effectively improve coagulation function and prognosis, improve the quality of life, and significantly shorten the rehabilitation process.%目的 探究乌司他丁联合连续性血液净化对ICU脓毒症患者血清乳酸(LAC)、降钙素原(PCT)、C反应蛋白(CRP)水平及康复进程的影响.方法 选取2014年1月至2016年5月本院68例ICU脓毒症患者,依据治疗方案不同分组,各34例.对照组行连续性血液净化治疗,研究组予以连续性血液净化+乌司他丁治疗.并对比治疗前及疗程结束后两组血清LAC、PCT、CRP、凝血功能相关指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、血小板计数(PLT)]、生活质量及预后相关指标[多器官功能衰竭评分(SOFA)、急性生理与慢性健康评分(APACHEII)]变化情况,并统计两组ICU入住时间、随访1年病死率.结果 两组治疗前血清LAC、PCT、CRP及凝血功能指标APTT、PT、PLT水平比较差异均无统计学意义(均P>0.05);相较于对照组,治疗后研究组血清LAC、PCT、CRP、APTT、PT水平均较低,PLT水平较高,差异均有统计学意义(均P<0.05);两组治疗前物质生活状态、心理、躯体、社会功能评分、SOFA、APACHEII评分比较差异均无统计学意义(均P>0.05);相较于对照组,治疗后研究组物质生活状态、心理、躯体及社会功能评分均较高,SOFA、APACHEII评分均较低,差异均有统计学意义(均P<0.05);研究组ICU入住时间少于对照组[(10.75±2.43)d比(15.26±3.31)d],随访1年病死率低于对照组(5.88％ 比23.53％),差异均有统计学意义(均P<0.05).结论 对ICU脓毒症患者联合采用乌司他丁、连续性血液净化治疗,可显著降低血清LAC、PCT、CRP水平,有效改善机体凝血功能及预后、提高生活质量,显著缩短康复进程.