Clinical Efficacy of Ulinastatin Combined with Continuous Renal Replacement in Treatment of Patients with Septic Shock

HU Qiong-hua; ZHOU Yu; ZHANG Ming; CUI Wei; XU Zhi-bo; GAO Ke; XU Bing

doi:10.3969/j.issn.1002-3429.2018.02.016

Abstract：Objective To observe clinical effect of Ulinastatin combined with continuous renal replacement in treat-ment of patients with septic shock. Methods A total of 901 patients with septic shock,who had met the inclusion and exclu-sion criteria,were divided into group A, B and C (n=30 for each group) using computer random number table method. Group A was given routine therapy,and group B was added with continuous renal replacement therapy(CRRT),while group C was added with Ulinastatin combined with CRRT on the basis of routine therapy. Blood leukocytes,procalcitonin(PCT),c-reactive protein (CRP),interleukin-6 (IL-6), interleukin-10 (IL-10), tumor necrosis factor alpha (TNF-α), blood lactic acid (Lac),oxygenation index (PaO2/FiO2), serum creatinine (SCr), blood urea (BUN) level and acute physiology and chronic health evaluation system II(APACHE II) scores before and at 3 and 7 days after treatment,and fatality rates at 3 and 7 days after treatment were observed and compared in three groups. Results In three groups,at 3 and 7 days after treatment, blood leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels,and APACHE II scores were significantly de-creased,while PaO2/FiO2values were significantly higher than those before treatment, and with increasing treatment time, decreased blood leukocytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels and APACHE II scores were more obvious,while increased PaO2/FiO2values were also more obvious, and the differences were statistically significant (P <0.05). At 3 and 7 days after treatment,there were significant differences in leukocytes, PCT, CRP, IL-6, IL-10, TNF-α,Lac,PaO2/FiO2,SCr and BUN levels and APACHE II scores among three groups (P<0.05). In group B and C, leuko-cytes,PCT,CRP,IL-6,IL-10,TNF-α,Lac,SCr and BUN levels, and APACHE II scores were significantly lower, while PaO2/FiO2values were significantly higher than those in group A;in group C,leukocytes,PCT,CRP,IL-6,IL-10,TNF-α, Lac,SCr and BUN levels,and APACHE II scores were significantly lower,while PaO2/FiO2values were significantly higher than those in group B(P<0.05). At 3 and 7 days after treatment,there were significantly differences in mortality rate among three groups (P<0.05),and the fatality rates in group B and C were significantly lower than that in group A (P<0.05). Conclusion Ulinastatin combined CRRT in treatment of patients with septic shock may inhibit inflammatory reaction, in-crease blood flow of tissue reperfusion by removing inflammatory factors,improve hemodynamics and maintain a stable internal environment so as to reduce fatality rate.