| Objective: To explore the efficacy and immunological mechanism of Ulinastatin and Rhubarb alone or in combination with ICU sepsis patients.Methods: The ICU sepsis patients from September 2015 to March 2017 was selected as the trial and a single-blind,parallel-controlled trial was conducted.According to the random number table method,the selected subjects were divided into 4 groups,and the number of unqualified cases was eliminated.The course of treatment was five days.The first group is the control group,given the standard treatment program,including:(1)active control of the primary disease,according to the original disease changes,blood routine,microbiology and other evidence,Selection,adjustment of antimicrobial drugs;(2)To give appropriate breathing support,to maintain a stable cycle,and to correct the organization and organs of inadequate perfusion;(3)According to the disease status and tne tolerance of patients to adjust the appropriate nutritional support program;(4)timely correction of electrolyte and acid-base balance disorders;(5)the comprehensive treatment of previous diseases.The second group is the Ulinastatin group,the patient in the standard treatment program based on the addition of Ulinastatin 200,000 units intravenous injection,three times a day.The third group is the rhubarb group,the patient in the standard treatment program based on the use of rhubarb laxative partic les 12 g nasal feeding or oral,once a day.The fourth group is the joint group,the patient in the standard treatment program based on the addition of uranastatin 200,000 units intravenous injection,three times a day,and plus rhubarb laxative partic les 12 g nasal feeding or oral,once a day.The data before and after the trial were recorded,(1)Baseline s ituation of the subjects: including sex,age,primary disease,etc.(2)general clinical features: inc luding body temperature,heart rate,respiratory rate,mental state,blood glucose;(3)inflammation response indicators: including white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT);Liver and kidney function indicators: inc luding serum creatinine,alanine aminotransferase,aspartate aminotransferase and tissue perfusion indicators: lactic acid;(5)acute phys iology and chronic health score Ⅱ(APACHE Ⅱ);(6)T lymphocyte subsets measured by flow cytometry,including CD3 +,CD4 +,CD8 + percentage and CD4 + / CD8 + ratio;(7)The treatment of the patient,the adjustment of the treatment plan and the length of hospitalization,the cost of hospitalization,the time of use of the ventilator,the situation of the outcome and so on.Results:1 A total of 87 subjects were selected from the study.Twelve cases were removed during the trial and 75 cases were divided into control group,ulinastatin group,rhubarb group and combined group.There were no statistically significant differences in the gender,age,and APACHE Ⅱ scores of the four groups(P<0.05).2 There APACHE Ⅱ scores were significant differences between the four groups before and after(P<0.05).Among them,the Ulinastatin group,rhubarb group and combination group have significant differences(P<0.01).There were differences between the control group and the other three groups,but there was no significant difference between the other three groups.3 The WBC was significant differences(P<0.05)between the four groups before and after except for the control group.There was a significant difference between the control group and the other three groups(P<0.01),and there was no significant difference between the other three groups.Factor analys is showed that ulinastatin and rhubarb all had a major effect,and there was no interaction effect.4 There were differences between the four groups(P<0.05)in CRP.Among ulinastatin group,rhubarb group and combination group,there were significant differences(P<0.01).After treatment,there was a significant difference between the three groups and the control group(P<0.05).Factor analys is revealed that there was an interaction effect between ulinastatin a nd rhubarb.5 There were no differences in the four groups of PCT when selected.There were differences only in combined groups before and after treatment(P<0.05).6 There was no significant difference in the creatinine value,alanine aminotransferase and aspartate aminotransferase(P>0.05)when selected.And there was no significant difference between the four groups after the course of treatment(P>0.05).7 There were differences between the four groups(P<0.05)in lactic acid value.Among ulinastatin group,rhubarb group and combination group,there were s ignificant differences(P<0.01).The lactic acid values of the latter three groups were different from the control group(P<0.05).There were no significant differences in the lactic acid values between the three groups after treatment.8 There was no significant difference between the four groups of T lymphocyte subsets(P>0.05)when selected.There were no significant differences between the four indexes in the control group(P>0.05).There were significant differences between the four indexes in the ulinastatin group(P<0.05).There was no significant difference in CD3 + percentage in rhubarb group before and after(P> 0.05).CD4 +,CD8 + percentage and CD4 + / CD8 + ratio were s ignificantly different(P<0.05)in rhubarb group,and CD4 + / CD8 + ratio has the existence of significant differences before and after treatment.The results of the combined group were the same as those of the rhubarb group.9 No significant adverse events were observed in the course of clinical trials with Ulinastatin and rhubarb laxative particles.Conclusions:1 Ulinastatin and rhubarb can reduce APACHE score to a certain extent,improve the severity of sepsis,combined group failed to play a better role than single drug application.2 Ulinastatin and rhubarb can improve the metabolism of patients with sepsis to a certain extent,but still can not think that the combination of two drugs to improve tissue perfusion ability is better than a single drug.3 When the sepsis patients improved condition CRP will decline,but ulinastatin and rhubarb can improve the degree of CRP decline,combined with no obvious advantages.4 It is not possible to think that both drugs are effective for improving PCT in patients with sepsis.5 Ulinastatin and rhubarb have the effect of reducing the white blood cell count in sepsis patients,but the combination of the two drugs can not make the white blood cell count drop better.6 Ulinastatin and rhubarb had no significant effect on liver and kidney function in patients with sepsis.7 Uzetatin can regulate CD3 +,CD4 +,CD8 + percentage and CD4 + / CD8 + ratio,which is beneficial to increase the immunity of sepsis patients.Rhubarb can not increase the proportion of CD3 + cells,but can regulate CD4 +,CD8 + percentage,affect CD4 + / CD8 + ratio,so rhubarb is good for sepsis patients with immune capacity.And we can not be considered a combination of two drugs better than single drug. |
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