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目的:评价常规剂量乌司他丁联合早期目标导向治疗对脓毒性休克患者的治疗效果。方法:将符合脓毒性休克诊断的47例患者随机分为两组,对照组24人(早期目标导向治疗)及观察组23人(早期目标导向治疗+乌司他丁20万单位/次,2次/天,连续应用7天)。在治疗过程中观察患者的血流动力学指标,乳酸值变化及血管活性药物的应用情况,同时记录机械通气的时间、ICU住院时间,观察28天患者住院死亡率。结果:47例脓毒性休克患者在治疗后的6、12、24、48、72小时动脉压上升、血乳酸值降低,具有显著差异(P<0.05);并且在治疗后的24,48,72小时患者的心率减慢,更加趋于稳定(P<0.05)。实验组血管活性药物用量较对照组减少,但无显著差异(P>0.05)。在治疗后的第3、5、7天观察组较对照组SOFA评分降低并具有统计学差异(P<0.05),APACHE-II评分两组间无显著差异(P>0.05)。实验组患者机械通气的时间明显短于对照组(P<0.05),两者28天住院死亡率未见明显差别(P>0.05)。结论:常规剂量乌司他丁联合早期目标导向治疗可以改善脓毒性休克患者的血流动力学,缩短其在ICU的住院天数,降低机械通气时间。
Objective: To evaluate the curative effect of conventional ulinastatin combined with early targeted therapy on patients with septic shock. Methods: Forty-seven patients eligible for septic shock were randomly divided into two groups: control group (early target-directed therapy) and observation group (23) (early target-directed therapy + ulinastatin (200,000 units / Times / day, continuous application of 7 days). During the course of treatment, the hemodynamic indexes, changes of lactic acid value and the application of vasoactive drugs were observed. At the same time, the time of mechanical ventilation, length of stay in ICU and in-hospital mortality were observed. Results: In 47 septic shock patients, the arterial pressure increased at 6, 12, 24, 48 and 72 hours after treatment, and the blood lactic acid value decreased significantly (P <0.05). After treatment, 24, 48 and 72 Hour heart rate slowed down, more stable (P <0.05). The amount of vasoactive drugs in the experimental group decreased compared with the control group, but there was no significant difference (P> 0.05). On the 3rd, 5th, 7th day after treatment, the SOFA score of the observation group was significantly lower than that of the control group (P <0.05). There was no significant difference between the two groups in the APACHE-II score (P> 0.05). The experimental group patients with mechanical ventilation was significantly shorter than the control group (P <0.05), both 28-day hospital mortality was no significant difference (P> 0.05). CONCLUSION: Conventional dose ulinastatin combined with early targeted therapy can improve the hemodynamics of patients with septic shock, shorten the hospital stay in ICU and reduce the duration of mechanical ventilation.