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目的:观察乌司他丁对脓毒性休克患者肺毛细血管通透性和复苏效果的影响,以探讨其作用及途径。方法:回顾性分析我院急诊科和重症医学科50例脓毒性休克患者的临床资料,包括治疗前和治疗24h后患者的血流动力学参数、炎性指标、乳酸、氧合作用、复苏所用液体量及血管活性药物,根据是否使用乌司他丁治疗,分为乌司他丁组(25例)和对照组(25例)。结果:乌司他丁组血管外肺水指数(PVPI)、肺血管通透性指数(EVLWI)、氧合作用的改善明显优于对照组(P<0.05),乌司他丁组复苏胶体液用量低于对照组(P<0.05),2组白蛋白用量比较差异有统计学意义(P<0.01)。结论:乌司他丁通过减轻脓毒性休克患者血管通透性,减少血管外肺水来改善循环灌注和组织氧合作用,可以降低复苏胶体需要量,提高复苏质量和效果。
Objective: To observe the effects of ulinastatin on pulmonary capillary permeability and resuscitation in patients with septic shock, and to explore its role and approach. Methods: The clinical data of 50 patients with septic shock in our emergency department and intensive care department were retrospectively analyzed. The hemodynamic parameters, inflammatory parameters, lactic acid, oxygenation and recovery were used before and 24 h after treatment Fluid volume and vasoactive drugs were divided into ulinastatin group (n = 25) and control group (n = 25) depending on whether ulinastatin was used or not. Results: The improvement of extracorporeal pulmonary water index (PVPI), pulmonary vascular permeability index (EVLWI) and oxygenation of ulinastatin group was significantly better than that of the control group (P <0.05) (P <0.05). There was significant difference in the amount of albumin between the two groups (P <0.01). Conclusion: Ulinastatin can reduce the need of recovery colloid and improve the quality and effect of resuscitation by relieving vascular permeability of patients with septic shock and reducing extravascular lung water to improve circulation perfusion and tissue oxygenation.