小剂量糖皮质激素联合乌司他丁治疗脓毒症临床效果及对患者微循环影响.docVIP

小剂量糖皮质激素联合乌司他丁治疗脓毒症临床效果及对患者微循环影响 　　摘 要 目的：观察小剂量糖皮质激素联合乌司他丁治疗脓毒症的临床效果及对患者微循环的影响。方法：将82例脓毒症患者随机分为3组，A组27例给予甲基强的松龙静脉注射，B组27例给予乌司他丁静脉注射，C组28例给予联合治疗，观察临床疗效及微循环指标。结果：A组有效15例（55.6%），B组有效20例（77.8%），C组有效25例（92.9%），C组显著优于A、B组（χ2=8.399，P=0.015）。治疗6 d后，3组炎症因子水平及微循环指标均改善，C组显著优于A、B组（P0.05）。结论：小剂量糖皮质激素联合乌司他丁通过改善脓毒症患者微循环发挥治疗作用。 　　关键词 脓毒症 糖皮质激素 乌司他丁 联合用药 微循环 　　中图分类号：R631 文献标识码：B 文章编号：1006-1533（2018）05-0032-03 　　Clinical effect of low dose of glucocorticoid combined with ulinastatin in the treatment of sepsis and its influence on microcirculation of patients 　　WANG Li， WANG Jiao 　　（Department of Emergency， the People’s Hospital of Shenzhen City， Shenzhen 518020， China） 　　ABSTRACT Objective： To observe the clinical effects of low dose of glucocorticoid combined with ulinastatin in the treatment of sepsis and its influence on microcirculation of patients. Methods： Eighty-two cases of patients with sepsis were randomly divided into group A， B and C. Group A was treated with methylprednisolone intravenous injection， group B with ulinastatin intravenous injection while group C with both methylprednisolone and ulinastatin. The clinical efficacy and the microcirculation indexes were observed. Results： There were 15 cases cured （55.6%） in group A， 20 cases cured （77.8%） in group B and 25 cases cured （92.9%） in group C. The clinical efficacy was significantly better in group C than in group A and B（χ2=8.399， P=0.015）. The inflammatory factors and microcirculation indexes were all improved in the three groups 6 days after treatment and significantly better in group C than in group A and B （P0.05）. Conclusion： The combination of small dose of glucocorticoid with ulinastatin can play a therapeutic role in improving microcirculation of the patients. 　　KEY WORDS sepsis； glucocorticoids； ulinastatin； combined medication； microcirculation 　　糖皮?|激素具有减少炎症因子释放进而阻碍炎症反应进程的作用，乌司他丁作为一种广谱蛋白酶抑制剂对多种蛋白酶具有一定的抑制作用，能够有效抑制炎性反应、保护器官损伤[1-2]。国内外相关文献报道糖皮质激素、乌司他丁治疗脓毒症较多，但联合用药效果及对脓毒症患者微循环的影响研究较少，本研究对此进行初步探讨。