前列地尔对脓毒症胃肠功能障碍的临床观察

摘要

目的 评价前列地尔对脓毒症患者胃肠功能障碍的临床疗效,并探讨其可能的机制.方法 以收治的脓毒症伴有胃肠功能障碍的患者96例为研究对象,将符合标准的患者随机分为对照组(47例)和前列地尔组(49例).对照组给予标准的治疗;前列地尔组在标准治疗的基础上,给予前列地尔(10 μg/2 mL) 10μg,静脉点滴,2次/d,连续7d.入组后分别在1、3、6d时记录2组监测指标.监测患者的一般情况、APACHEⅡ评分、SOFA评分、胃肠功能障碍评分、乳酸、D-乳酸、ICU停留时间、住院随访、28 d随访、免疫指标(sIgA、CD4+/CD8+)、炎症指标(白细胞、中性粒细胞百分比/％、血沉、C-反应蛋白、降钙素原、白介素-6).结果 在治疗3、6d时,2组患者的APACHEⅡ评分、SOFA评分、胃肠功能障碍评分、D-乳酸、WBC、N％、C反应蛋白、降钙素原、白介素-6均较治疗前及治疗1d时下降,而且在6d时前列地尔组较对照组下降明显(P＜ 0.05);sIgA、CD4+/CD8+在治疗3、6d时较治疗前及1d时明显升高,而且6d时前列地尔组明显高于对照组(P＜0.05).前列地尔组的AGIⅡ级、Ⅲ级、Ⅳ级患者的比率随治疗明显下降,尤其6d时比率下降明显低于对照组.前列地尔组ICU住院时间及总住院时间均明显低于对照组(P＜0.05);前列地尔组住院病死率及28 d病死率均低于对照组(P＜0.05).结论 前列地尔可以改善脓毒症患者的胃肠功能障碍,可能与前列地尔改善肠道微循环障碍、降低炎症反应和提高免疫力有关,从而缩短了ICU停留时间及总住院时间,降低了病死率.%Objective To evaluate the clinical efficacy of alprostadil in patients with sepsis and AGI,and to explore its possible mechanism.Methods From January 2015 to June 2016,patients with sepsis and AGI were involved in the study in the department of critical care medicine of our hospital.Patients conforming to the enrolled standard were randomly divided into the control group and alprostadil group.The standard treatment was given to the control group while alprostadil 10 μtg 2/d was given to the alprostadil group based on standard treatment.Monitoring indexes were recorded on 1 d,3 d and 6 d.Monitored items included the APACHE Ⅱ score,SOFA score,Gastrointestinal dysfunction score,lactic acid,D-lactic acid,ICU stay time,hospital follow-up,28 day follow-up,immune index (sIgA,CD4+/CD8+),inflammatory markers (WBC,N/％,C reactive protein,procalcitonin,interleukin-6).Results 96 patients were included in this study,with 47 cases in the control group and 49 cases in the alprostadil group.In the 3-d and 6-d treatment,APACHEII score,SOFA score,gastrointestinal dysfunction score,lactic acid,D-lactic acid,WBC,N/％,C reactive protein,procalcitonin and intedeukin-6 were significantly decreased,compared with prior treatment and 1 d,and those in the alprostadil group were lower in the 6 d than those in the control group (P ＜ 0.05);at the same time,those indexes such as sIgA,CD4+/CD8+ were significantly increased in the treatment of 3 d and 6 d than prior treatment and 1 d,and especially on 6 d,they were significantly higher than control group (P ＜ 0.05).The ratios of AGI Ⅲ level,Ⅲ level and Ⅳ level of alprostadil group decreased significantly,especially on the 6 d and then dropped significantly compared with the control group.ICU stay and hospital stay in the alprostadil group were respectively lower than the control group (P ＜ 0.05);hospital mortality and the 28 d mortality rate in the alprostadil group were significantly lower than the control group (P ＜ 0.05).Conclusion Alprostadil in the time of sepsis combined with AGI can improve gastrointestinal function,reduce the time of ICU stay and hospital stay and lower the mortality rate,which could be associated with alprostadil that reduces systemic inflammatory reaction and improves immunity by improving microcirculation.