李炬靈
【摘要】 目的 探究臨床用烏司他丁輔助治療重癥感染性休克的治療效果。方法 90例重癥感染性休克患者, 隨機(jī)分為觀察組與對(duì)照組, 每組45例。對(duì)照組患者采用西醫(yī)常規(guī)治療, 觀察組患者在對(duì)照組基礎(chǔ)上聯(lián)合烏司他丁治療。比較兩組患者治療效果、體溫情況、感染情況以及治療前后白細(xì)胞計(jì)數(shù)、白細(xì)胞介素-6(IL-6)水平、格拉斯哥昏迷量表(GCS)評(píng)分、急性生理功能和慢性健康狀況評(píng)分系統(tǒng)Ⅱ(APACHEⅡ)評(píng)分。結(jié)果 治療后, 觀察組白細(xì)胞計(jì)數(shù)(7.34±1.32)×109/L低于對(duì)照組的(9.41±1.16)×109/L, 差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后, 觀察組高熱、感染體征發(fā)生率分別為97.78%、86.67%, 均高于對(duì)照組的82.22%、62.22%, 差異具有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組體溫恢復(fù)時(shí)間、感染消失時(shí)間分別為(7.19±1.39)、(3.88±0.89)d, 均短于對(duì)照組的(9.81±1.88)、(10.76±1.57)d, 差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組患者血清IL-6為(4.27±0.95)μg/L低于對(duì)照組的(9.58±1.07)μg/L, 差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組患者GCS評(píng)分和APACHEⅡ評(píng)分較治療前均有所改善, GCS評(píng)分(8.19±1.59)分、APACHEⅡ評(píng)分(8.83±0.82)分均優(yōu)于對(duì)照組的(6.81±1.82)、(14.71±3.52)分, 差異均具有統(tǒng)計(jì)學(xué)意義(P<0.05)。觀察組患者治療總有效率95.56%明顯高于對(duì)照組的77.78%, 差異具有統(tǒng)計(jì)學(xué)意義(χ2=6.154, P<0.05)。結(jié)論 烏司他丁具有較好的抗炎效果, 與西醫(yī)治療相結(jié)合可以提高臨床療效, 加快重癥感染性休克患者退熱速度, 縮短感染時(shí)間, 降低白細(xì)胞計(jì)數(shù)及血清IL-6水平, 改善GCS評(píng)分和APACHEⅡ評(píng)分, 臨床療效較好。
【關(guān)鍵詞】 烏司他丁;重癥感染性休克;白細(xì)胞水平;聯(lián)合治療
DOI:10.14163/j.cnki.11-5547/r.2020.12.002
【Abstract】 Objective? ?To investigate the therapeutic effect of ulinastatin in the treatment of severe septic shock. Methods? ?A total of 90 severe septic shock patients were randomly divided into observation group and control group, with 45 cases in each group. The control group was treated by conventional Western medicine, and the observation group was treated by ulinastatin on the basis of the control group. The therapeutic effect, body temperature recovery time , infection disappearance time, white blood cell count, interleukin-6 (IL-6) level, Glasgow coma scale (GCS) score, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were compared between the two groups. Results? After treatment, the white blood cell count (7.34±1.32)×109/L?of the observation group was lower than that of the control group (9.41±1.16)×109/L, and the difference was statistically significant (P<0.05). After treatment, the body temperature recovery time and infection disappearance time of the observation group were (7.19±1.39) and (3.88±0.89) d, which were all shorter than those of the control group (9.81±1.88) and (10.76±1.57) d, and the difference was statistically significant (P<0.05). After treatment, the serum IL-6 of the observation group was (4.27±0.95) μg/L, which was lower than that of the control group (9.58±1.07) μg/L,?and the difference was statistically significant (P<0.05). GCS score and APACHEⅡ score of the two groups were all better than those before treatment of the same group, and GCS score (8.19±1.59) points and APACHEⅡ score (8.83±0.82) points of the observation group were all better than those of the control group (6.81±1.82) and (14.71±3.52) points, and the difference was statistically significant (P<0.05). The total effective rate of the treatment 95.56% of the observation group was obviously higher than that of the control group 77.78%, and the difference was statistically significant (χ2=6.154, P<0.05). Conclusion? Ulinastatin has a good anti-inflammatory effect. Combined with Western medicine, it can improve the clinical efficacy, accelerate the speed of fever reduction in severe septic shock patients, shorten the infection time, reduce the white blood cell count and serum IL-6 levels, improve the GCS score and APACHE Ⅱscore. The clinical efficacy is good.
綜上所述, 烏司他丁具有較好的抗炎效果, 與西醫(yī)治療相結(jié)合可以提高臨床療效, 加快重癥感染性休克患者退熱速度, 縮短感染時(shí)間, 降低白細(xì)胞計(jì)數(shù)及血清IL-6水平, 改善GCS評(píng)分和APACHEⅡ評(píng)分, 臨床療效較好。
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[收稿日期:2020-01-03]