脓毒症
ENGLISH ABSTRACT
乌司他丁注射液对脓毒症患者左心室舒张功能的影响
陆胜
邵杰
庾胜
张健峰
沙俊
冯玉峰
作者及单位信息
·
DOI: 10.3760/cma.j.issn.1671-0282.2023.06.010
Effect of ulinastatin injection on left ventricular diastolic function in patients with sepsis
Lu Sheng
Shao Jie
Yu Sheng
Zhang Jianfeng
Sha Jun
Feng Yufeng
Authors Info & Affiliations
Lu Sheng
Intensive Care Unit, Changshu NO.2 People’s Hospital, Soochou 215500, China
Shao Jie
Intensive Care Unit, Changshu NO.2 People’s Hospital, Soochou 215500, China
Yu Sheng
Intensive Care Unit, Changshu NO.2 People’s Hospital, Soochou 215500, China
Zhang Jianfeng
Intensive Care Unit, Changshu NO.2 People’s Hospital, Soochou 215500, China
Sha Jun
Intensive Care Unit, Changshu NO.2 People’s Hospital, Soochou 215500, China
Feng Yufeng
Intensive Care Unit, Changshu NO.2 People’s Hospital, Soochou 215500, China
·
DOI: 10.3760/cma.j.issn.1671-0282.2023.06.010
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摘要

目的探讨乌司他丁注射液对脓毒症患者左心室舒张功能及预后的影响。

方法选取在2021年1月至2022年3月收住重症医学科的脓毒症患者100例,按照随机数字表将他们分为对照组(常规治疗)和试验组(常规治疗+乌司他丁干预)。比较两组患者入院时基线资料;观察并比较两组患者入院时和治疗后第7天的心脏超声指标[舒张早期二尖瓣血流峰速度/舒张早期二尖瓣环速度(E/e')、舒张早期二尖瓣环速度(e')、舒张早期二尖瓣血流峰速度/舒张晚期二尖瓣血流峰速度(E/A)、三尖瓣反流峰速度(TRV)],心肌损伤与心功能相关指标[肌钙蛋白I(cTnI)、N端脑钠肽前体(NTproBNP)]和炎症相关指标[超敏C反应蛋白(CRP)、降钙素原(PCT)、红细胞沉降率(ESR)],ICU住院时间,感染控制时间,血管活性药物使用时间和28 d病死率的差异,并进行统计学分析。

结果在治疗后第7天,试验组与对照组相比,e'、E/A水平显著升高;E/e'、TRV、cTnI、NTproBNP、CRP、PCT水平显著降低,差异有统计学意义( P<0.05)。试验组和对照组之间的感染控制时间和血管活性药物使用时间比较,差异无统计学意义( P>0.05),但试验组的ICU住院时间和28 d病死率均显著低于对照组,差异有统计学意义( P<0.05)。

结论乌司他丁可以降低脓毒症的炎症反应程度,改善心肌损伤,改善左心室舒张功能,减少ICU住院时间和降低患者28 d病死率。

脓毒症;左心室舒张功能;心功能障碍;乌司他丁注射液;炎症反应
ABSTRACT

ObjectiveTo investigate the effect of ulinastatin injection on left ventricular diastolic function and prognosis in patients with sepsis.

MethodsA total of 100 patients with sepsis admitted to the Intensive Care Unit from January 2021 to March 2022 were selected. According to the random number table, they were randomly (random number) divided into the control group (conventional treatment) and experimental group (conventional treatment + ulinastatin injection). The baseline data on admission were compared between the two groups. The echocardiographic indexes [mitral peak velocity of early filling/early diastolic mitral annular velocity (E/e'), early diastolic mitral annular velocity (e'), mitral peak velocity of early filling/ mitral peak velocity of late filling (E/A), and tricuspid regurgitation rate (TRV)], myocardial damage-related and cardiac function-related indicators [troponin I (cTnI), N terminal pro B type natriuretic peptide (NTproBNP)] and inflammation-related indicators [C-reaction protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR)], length of ICU stay, duration of infection control, duration of vasoactive drug use and 28-day mortality were observed and compared between the two groups on admission and 7 days after treatment.

ResultsOn the 7th day after treatment, the levels of e 'and E/A in the experimental group were significantly higher than those in the control group, and the levels of E/e', TRV, cTnI, NTproBNP, CRP and PCT were significantly decreased ( P<0.05). There were no significant differences in duration of infection control and duration of vasoactive drug use between the experimental group and the control group ( P<0.05), but the length of ICU stay was shorter and 28-day mortality was significantly lower in the experimental group than in the control group ( P<0.05).

ConclusionsUlinastatin can reduce the degree of inflammatory response, relieve myocardial injury, improve left ventricular diastolic function, and reduce the length of ICU stay and 28-day mortality in patients with sepsis.

Sepsis;Left ventricular diastolic function;Cardiac dysfunction;Ulinastatin injection;Inflammatory response
Feng Yufeng, Email: mocdef.3ab6171383260731
引用本文

陆胜,邵杰,庾胜,等. 乌司他丁注射液对脓毒症患者左心室舒张功能的影响[J]. 中华急诊医学杂志,2023,32(06):775-780.

DOI:10.3760/cma.j.issn.1671-0282.2023.06.010

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*以上评分为匿名评价
脓毒症是患者入住重症医学科的主要病因之一,表现为感染引起的全身炎症反应和自身免疫失调所导致的微循环障碍,严重者可并发多器官功能障碍 [ 1 ],是威胁人类生命健康的疾病之一。在脓毒症中,全身各个脏器均可能受累,但心脏往往是最早受累也是最常受累的器官 [ 2 , 3 ]。Huang等 [ 4 ]的研究发现,尽管脓毒症同时合并心脏收缩和舒张功能的障碍,但是心脏收缩功能与预后无明显的相关性,而左心室舒张功能可能是影响脓毒症患者预后的关键性因素。目前临床上针对脓毒症的治疗措施主要为早期液体复苏、积极抗感染、改善氧合、纠正缺氧、免疫调节、营养支持及其他器官支持治疗。在上述治疗方案的基础上,心室舒张功能障碍方面的治疗以对症支持治疗为主,尚无特效治疗方案。乌司他丁注射液是一种尿胰蛋白酶抑制剂,在临床上被广泛使用,早期主要用来治疗急性胰腺炎,近年来成为脓毒症、重症肺炎等治疗的常用药 [ 5 , 6 ],但其在心功能障碍尤其是舒张功能障碍治疗方面的作用还有待于进一步研究。基于此,本研究探讨了使用乌司他丁注射液对脓毒症患者左心室舒张功能的影响,现报道如下。
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备注信息
A
冯玉峰,Email: mocdef.3ab6171383260731
B

陆胜:数据收集及整理、统计学分析、论文撰写;邵杰、庾胜:工作支持、研究设计;冯玉峰:研究设计、论文修改;张健峰、沙俊:采集数据、技术支持

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