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目的评价乌司他丁联合连续性肾替代疗法(CRRT)治疗多器官功能障碍综合征(MODS)的临床疗效。方法选取2013年7月至2015年7月河北省衡水市哈励逊国际和平医院重症医学科收治的68例MODS患者,分成对照组(23例)、CRRT组(22例)、联合组(23例)。记录治疗前,治疗72h、1周后的急性生理学及慢性健康状况评分系统(APACHE-Ⅱ)评分、序贯性器官衰竭评估(SOFA)评分、炎症指标的变化情况及炎症介质水平,比较入住ICU的病死率。结果治疗72h、1周后,CRRT组及联合组患者白细胞介素(IL)-10、IL-6、肿瘤坏死因子α(TNF-α)、白细胞计数(WBC)、降钙素原(PCT)、C反应蛋白(CRP)水平明显优于对照组(P<0.05),而联合组优于CRRT组(P<0.05)。治疗72h、1周后,CRRT组及联合组氧合指数、乳酸、丙氨酸氨基转移酶(ALT)较对照组明显改善(P<0.05),联合组改善更显著(P<0.05)。在治疗1周后,CRRT组及联合组病死率明显低于对照组(P<0.05),而CRRT组和联合组比较差异无统计学意义(P>0.05)。结论乌司他丁联合CRRT是治疗MODS的有效方法。
Objective To evaluate the clinical efficacy of ulinastatin combined with continuous renal replacement therapy (CRRT) in the treatment of multiple organ dysfunction syndrome (MODS). Methods Sixty-eight patients with MODS were enrolled from July 2013 to July 2015 in the Hetun International Peace Hospital of Hengshui City, Hebei Province. They were divided into control group (23 cases), CRRT group (22 cases), combined group (23 cases) example). The APACHE-Ⅱ score, the sequential organ failure assessment (SOFA) score, the change of inflammatory index and the level of inflammatory mediators were recorded before treatment, 72h and 1 week after treatment, Case fatality rate. Results The levels of IL-10, IL-6, TNF-α, WBC, procalcitonin (PCT) in CRRT group and combined group were significantly higher than those in control group , C-reactive protein (CRP) levels were significantly better than the control group (P <0.05), while the combination group CRRT group (P <0.05). The oxygenation index, lactic acid and alanine aminotransferase (ALT) of CRRT group and combined group were significantly improved (P <0.05), and the improvement of combined group was more significant (P <0.05) 72h after treatment. After 1 week of treatment, the mortality of CRRT group and combination group was significantly lower than that of control group (P <0.05), but there was no significant difference between CRRT group and combined group (P> 0.05). Conclusion Ulinastatin combined with CRRT is an effective treatment of MODS.