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

Effect of Ulinastatin adjuvant to high-volume hemofiltration on serum levels of ICAM-1, cholinesterase and coagulation function in patients with severe sepsis

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（APACHE Ⅱ）、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APACHE Ⅱ、SOFA及Marshall评分降低（P <0.05）。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（P <0.05）。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（P >0.05）。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（P <0.05）。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 study clinical efficacy of Ulinastatin adjuvant to high-volume hemofiltration in treating severe sepsis and its effects on serum levels of intercellular adhesion molecule-1 (ICAM-1), cholinesterase and coagulation function. Methods A total of 106 patients of severe sepsis in our hospital from January 2012 to December 2014 were collected as research objects and their clinical materials were retrospectively analyzed. According to therapeutic schemes, these patients were divided into control group (n = 47) and observation group (n = 59). Besides conventional treatments, the control group was treated with high-volume hemofiltration, while the observation group was treated with high-volume hemofiltration and Ulinastatin. Then, the scores of Acute Physiology and Chronic Health Evaluation Scoring System (APACHE Ⅱ), Sequential Organ Failure Assessment (SOFA) and Marshall, incidence of disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) and mortality, the coagulation function and serum levels of ICAM-1 and cholinesterase were compared between the two groups. Results After treatment for 7 days, the scores of APACHE Ⅱ, SOFA and Marshall were significantly lower in the observation group than those in the control group (P < 0.05). After treatment for 28 days, the incidence of DIC and MODS was 3.4% and 8.5% respectively in the observation group, which were significantly lower than those (17.0% and 23.4% respectively) in the control group (P < 0.05). The mortality of the observation group and the control group were 15.3% and 29.8% respectively, with no statistical difference (P > 0.05). After treatment, the prothrombin time and activated partial prothrombin time shortened, and the levels of fibrinogen and platelets increased in the observation group in comparison with the control group (P < 0.05). As to inflammatory factors, the level of ICAM-1 statistically decreased and cholinesterase increased in the observation group (P < 0.05). Conclusions Ulinastatin adjuvant to high-volume hemofiltration is effective in treating severe sepsis. It can significantly decrease ICAM-1 level, increase cholinesterase level and improve coagulation function, which is worthy of further study in future.