摘要
目的 观察乌司他丁对老年脓毒症患者肠粘膜屏障功能的影响，探讨老年脓毒症患者早期治疗的优化方案，为临床实践提供依据。方法 将入选的老年脓毒症患者随机分为基础治疗组（n=34例）和乌司他丁治疗组（n=34例）。分别于入住ICU当时与入住ICU后第2、3、7天（D0、D2、D3、D7）血清肠脂肪酸结合蛋白（IFABP）、二胺氧化酶（DAO）、D-乳酸（D-Lac）水平变化，并记录患者APACHE Ⅱ评分、ICU住院时间及28天生存情况。结果 （1）入科后，基础治疗组和乌司他丁治疗组患者APACHE Ⅱ评分、血浆IFABP、DAO、D-Lac水平均无明显差异（P＞0.05）；经治疗后，基础治疗组和乌司他丁治疗组患者的 APACHE Ⅱ评分，血浆IFABP、DAO、D-Lac水平均有所下降，但乌司他丁治疗组的下降趋势表现得更加明显，APACHE Ⅱ评分，血浆IFABP在各观察时间点均显著低于同时间点的基础治疗组（P＜0.05），DAO、D-Lac水平在D2和D3观察点乌司他丁组明显低于基础治疗组（P＜0.05），至D7时间点，两组无明显差异（P＞0.05）；血浆IFABP、DAO、D-Lac水平与APACHE II评分有显著相关性（P＜0.01），但与ICU住院时间无明显相关（P＞0.05）；两组28天死亡率无明显差异（P＞0.05）。结论 乌司他丁对老年脓毒症患者肠屏障功能具有保护作用，可以一定程度上改善老年脓毒症患者的预后，减少ICU住院时间，但对降低28d死亡率无明显作用。
Objective To observe the effect of Ulinastatin （UTI） on intestinal barrier function of elderly patients with sepsis in order to explore an optimized program of early treatment for such patients instituting a guidelines for clinical practice. Methods All selected patients randomly （ramdom number ） divided into conventional treatment group （n = 34 ） and UTI treatment group （n = 34）. Peripheral venous blood samples of elderly patients with sepsis were routinely taken at days 0, 2, 3, 7 （ DO, D2, D3, D7 ） after admission for detecting the changes of plasma values of Intestinal fatty acid binding protein （ IFABP ） , Diamine oxidase （DAO）, and D-lactate （D-Lac）. While patients＇ APACHE Hscores, length of ICU stay and 28 d mortality also were recorded at the same time. Results At admission, there were no significant differences in patients＇ APACHE Ⅱscores, plasma values of IFABP, DAO and D-Lac between two groups （ P 〉 0. 05）. During the course of treatment, the patients＇ APACHE Ⅱscores, plasma values of IFABP, DAO and D-Lac were declining in both groups, while those declinations in UTI group showed significantly more prominent. Compared with conventional therapy group, IFABP level was significantly lower in UTI group （P 〈 0. 05）, and the plasma values of DAO and D-Lae were significantly lower at D2 and 1）3 in UTI group （ P 〈 0. 05 ）, but not at D7 （ P 〉 0. 05 ）. The plasma levels of IFABP, DAO and D-Lac were positively associated with APACHE Ⅱscores, but not with length of ICUstay （P 〉 0. 05）. After treatment, 28d mortality did not differ significantly between the two groups （P 〉 0. 05）. Conclusions UTI has a protective effect on intestinal barrier function in elderly patients with sepsis. UTI can improve the prognosis of elderly patients with sepsis and reduce ICU stay, while has no significant effect on reducing 28 d mortality.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2016年第2期177-181,共5页
Chinese Journal of Emergency Medicine
基金
广东省自然科学基金（2015A030313735）、广东省省级科技计划项目（2014A020212651）
