关键词: 重症脓毒血症, 休克, 乌司他丁, 糖皮质激素, 氢化可的松

Abstract:

AIM: To study curative efficacy of ulinastatin combined with hydrocortisone in treatment of severe sepsis secondary shock and effects on serum factor levels. METHODS: 87 patients of severe sepsis secondary shock who received therapy from December 2015 to December 2017 in our hospital were selected as research objects. According to random number table, those patients were divided into the 43 cases of the control group and the 44 cases of the treatment group. The control group was treated with routine treatment, on the basis of the control group, the treatment group combined with intravenous drip of ulinastatin 200 thousand U into the 5% glucose solution 250 mL+intravenous infusion of 200 mg hydrocortisone into 5% glucose solution 250 mL, 1 times/d, they were continuous treatment for 2 weeks. The clinical efficacy, laboratory indexes, serum procalcitonin (PCT), IL-6, IL-10, mechanical ventilation time, hospitalization time, adverse drug reaction and 28 d mortality were compared between the 2 groups. RESULTS:After treatment, the total effective rate of the treatment group and the control group were 86.36%（38/44）and 67.44%（29/43）respectively, there was significant differences in comparison (P＜0.05). After treatment, the systolic pressure (SBP) of the treatment group and the control group were（85.82±6.25） and （78.80±9.26）mmHg, respectively; the C reactive protein (CRP) were (34.78±4.79) and (46.76±5.93) mg/L, respectively; the white blood cell count (WBC) were (7.85±2.02) and (12.49±2.14)×109/L, respectively; the PCT were (1.50±0.22) and (2.70±0.46) ng/mL, respectively; the IL-6 were（59.13±12.73）and（82.32±18.40）pg/mL, respectively; the IL-10 were （10.04±1.25）and （14.41±1.88）pg/mL respectively; the acute physiology and chronic health evaluation (APACHEⅡ) were（10.30±1.41）and（14.51±1.68）score, there were significant differences in comparison (P＜0.05). The mechanical ventilation time and hospitalization time in the treatment group were（10.02±1.65）d and（16.00±1.36）d, respectively, those in the control group were （17.58±2.54）d and（24.00±1.69）d, respectively; there were significant differences in comparison (P＜0.05). During the treatment period, there were no serious adverse reactions in the 2 groups, there were 1 cases of rash in the treatment group, and there was no significant difference in the incidence of adverse reactions between the 2 groups (P＞0.05). The 28 d mortality in the treatment group and the control group was 4.55%（2/44）and 20.93% (9/43), respectively, there was significant differences in comparison (P＜0.05). CONCLUSION:Ulinastatin combined with hydrocortisone is well for severe sepsis secondary shock, which can effectively relieve the disease, reduce the mortality, and have less adverse drug reactions and high safety.

Key words: severe sepsis, shock, ulinastatin, glucocorticoid, hydrocortisone