Objective To investigate the effect of continuous renal replacement therapy (CRRT) combined with ulinastatin on inflammatory factors,hemodynamic parameters and prognosis in patients with bum sepsis.Methods Thirty patients with bum sepsis enrolled from January 2014 to June 2017 in Affiliated Hospital of Nantong University were divided into observation group and control group,with 15 cases in each group.The control group was treated with CRRT;the observation group was treated with CRRT and intravenous administration of ulinastatin.Infection indexes,inflammatory factors and hemodynamic parameters were tested before and 1,3,5,7 d after treatment.Scores of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and multiple organ dysfunction syndrome (MODS) were recorded to evaluated the severity of sepsis.The mortality rate was analyzed.Results Levels of white blood cell count,procalcitonin (PCT) and C-reactive protein (CRP) in observation group were significantly lower than those in control group 3,5 d after treatment[3 d:(15.5 ± 1.7) ×109/L vs (18.6 ± 3.6) × 109/L,(10.3 ± 2.3) mg/L vs (13.3 ± 1.7) mg/L,(26 ± 13) mg/L vs (32 ± 10) mg/L;5 d:(13.3±2.4) ×109/L vs (15.5±2.2) × 109/L,(8.2±l.6)mg/L vs (10.2±2.2)mg/L,(20±8)mg/L vs (30 ± 8) mg/L] (P ＜ 0.05);PCT and CRP in observation group were significantly lower than those in control group7 daftertreatment[(4.7±l.7)mg/L vs (6.7 ±l.9)mg/L,(lO±8)mg/L vs (13 ±6)mg/L](P＜0.05).The level of tumor necrosis factor-α in observation group was significantly lower than that in control group 3,5 d after treatment [(56 ± 13) μg/L vs (62 ± 11) μg/L,(47 ± 10) μg/L vs (55 ± 13) μg/L] (P ＜ 0.05);interleukin-1 β,-6,-10 in observation group were significantly lower than those in control group 5 d after treatment [(59 ± 14) μg/L vs (67± 11) μg/L,(41 ±8) μg/L vs (46 ± 8) μg/L,(31.7 ±4.3) μg/L vs (33.6 ± 3.4) μg/L](P ＜ 0.05).The oxygenation index in observation group was significantly higher and the level of blood lactic acid was significantly lower than those in control group 3,5,7 d after treatment(P ＜ 0.05).Scores of APACHE Ⅱ and MODS significantly decreased 5,7 d after treatment and there were significant differences between observation group and control group[5 d:(14 ±4) points vs (18 ±4) points,(7.7 ± 3.4) points vs (10.7 ± 1.8) points;7 d:(12 ± 6) points vs (17 ± 5) points,(6.5 ± 3.2) points vs (9.8 ± 3.6) points] (P ＜ 0.05).The death rate in observation group was lower than that in control group[20.0％ (3/15) vs 33.3％ (5/15)] but the difference was not significant (P ＞ 0.05).Conclusion CRRT combined with ulinastatin treating burn sepsis can effectively improve hemodynamic status,lower inflammatory factors and improve the prognosis.%目的 探讨连续性肾脏替代治疗(CRRT)联合乌司他丁治疗对脓毒症患者炎性因子水平和.血流动力学参数及预后的影响.方法 选取2014年1月至2017年4月南通大学附属医院烧伤整形科收治的烧伤并发脓毒症患者30例,按照随机数字表法分为对照组和观察组,每组15例.对照组采用CRRT,观察组在对照组基础上联用乌司他丁.治疗前及治疗1、3、5、7d后检测感染指标、炎性因子及血流动力学指标变化,记录急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分和多器官功能障碍综合征(MODS)评分以评估疾病严重程度.记录2组患者的死亡率.结果 观察组治疗3、5d后白细胞计数、降钙素原、C反应蛋白明显低于对照组[3 d:(15.5±1.7)×109/L比(18.6±3.6)×109/L、(10.3±2.3)mg/L比(13.3±1.7)mg/L、(26±13) mg/L比(32 ±10)mg/L,5 d:(13.3±2.4)×109/L比(15.5±2.2)×109/L、(8.2±1.6)mg/L比(10.2±2.2)mg/L、(20±8)mg/L比(30±8)mg/L](均P＜0.05),治疗7d后降钙素原、C反应蛋白明显低于对照组[(4.7±1.7)mg/L比(6.7±1.9) mg/L、(10±8)mg/L比(13±6)rg/L](均P＜0.05).观察组治疗3、5d后肿瘤坏死因子α明显低于对照组[(56±13) μg/L比(62±11)μg/L、(47±10) μg/L比(55±13)μg/L](均P＜0.05),治疗5d后白细胞介素1β、6、10明显低于对照组[(59±14) μg/L比(67±11) μg/L、(41±8)μg/L比(46±8) μg/L、(31.7±4.3)μg/L比(33.6 ±3.4)μg/L] (P ＜0.05).治疗3、5、7d后观察组氧合指数明显高于对照组,血乳酸水平明显低于对照组(P＜0.05).治疗后2组APACHEⅡ、MODS评分均逐渐下降,治疗5、7d后均明显低于治疗前(P＜0.05),且观察组明显低于对照组[5 d:(14±4)分比(18 ±4)分、(7.7±3.4)分比(10.7±1.8)分,7 d:(12±6)分比(17±5)分、(6.5±3.2)分比(9.8±3.6)分](P＜0.05).观察组死亡率低于对照组[20.0％ (3/15)比33.3％ (5/15)],但差异无统计学意义(P＞0.05).结论 烧伤脓毒症患者行CRRT联合乌司他丁治疗可明显改善患者的血流动力学指标,降低炎性因子水平,改善预后.
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