论文部分内容阅读
目的:探讨乌司他丁对肝胆手术术后脓毒症患者的治疗作用。方法:回顾性分析2015-01-01-2016-12-31我院重症医学科收治的63例肝胆手术术后发生脓毒症患者,依据是否使用乌司他丁治疗分为治疗组(26例)与对照组(37例),收集2组患者的一般资料、炎症指标(白细胞、中性粒细胞、C反应蛋白)、乌司他丁治疗前与治疗第5天凝血酶原活动度(PTa)、脓毒症持续时间、术后ICU住院时间和术后总住院时间、28d存活情况,进行统计分析,比较2组差异。结果:治疗组乌司他丁使用剂量为90万U/d,平均使用时间5.3d;2组患者的年龄、性别、术后当日APACHII评分、入组时PTa比较差异均无统计学意义;治疗组患者入组时的SOFA评分更高(P<0.05)。对照组相比,治疗组的白细胞、中性粒细胞、CRP恢复至正常范围的平均时间更短,脓毒症治疗第5天PTa均值更高,脓毒症持续的平均时间更短,差异均有统计学意义(P<0.05);治疗组的术后平均ICU住院时间、术后平均总住院时间均较对照组更短,但差异无统计学意义;2组患者的28d病死率比较差异无统计学意义。结论:乌司他丁可减轻肝胆手术术后脓毒症患者的炎症反应,改善凝血功能,可能有助于缩短患者的术后ICU住院时间、术后总住院时间,但对病死率无影响。
Objective: To investigate the therapeutic effect of ulinastatin on patients with sepsis after hepatobiliary surgery. Methods: A retrospective analysis of 63 patients with sepsis after hepatobiliary surgery admitted to our hospital from January 2015 to January 2015 was performed according to whether ulinastatin was used or not (26 cases (Control group) and control group (37 cases). The general data of two groups were collected. Inflammatory index (leucocyte, neutrophil, C-reactive protein), prothrombin activity before and after treatment with ulinastatin ), The duration of sepsis, postoperative ICU hospital stay and postoperative total hospital stay, 28d survival, statistical analysis, compared two groups differences. Results: The dosage of ulinastatin in the treatment group was 900 000 U / d and the average use time was 5.3 days. There was no significant difference in the age, sex, APACHII score on the day after surgery and PTa between the two groups in the treatment group Patients in the cohort had higher SOFA scores (P <0.05). Compared with the control group, the mean time to recover the normal range of white blood cells, neutrophils and CRP in the treatment group was shorter, the average PTa was higher on the 5th day of sepsis treatment, and the average duration of sepsis was shorter, the difference was (P <0.05). The average postoperative ICU stay and postoperative average hospital stay in the treatment group were shorter than those in the control group, but the difference was not statistically significant. The 28-day mortality rate in the two groups was no significant difference Statistical significance. Conclusion: Ulinastatin can reduce the inflammatory reaction and improve the coagulation function of sepsis patients after liver and gallbladder surgery, which may help to shorten the postoperative ICU hospitalization time and postoperative total hospital stay, but have no effect on the mortality rate.