Observation On The Efficacy Of Ulinastatin In Patients With Severe Sepsis And Septic Shock Diagnosed In Emergency Room

Objective:Sepsis has rapid progression and high mortality.Inflammatory imbalance and immunosuppression are the core pathogenesis of sepsis.Previous studies have shown that ulinastatin(UTI)can inhibit inflammatory response,improve organ function and reduce mortality in hospitalized patients with sepsis,but the effect on early sepsis patients is not clear.The purpose of this study was to investigate the efficacy of UTI in the treatment of severe sepsis and septic shock diagnosed in emergency room.Methods: From January 2015 to December 2017,A total of 150 patients with severe sepsis and septic shock were selected from the emergency departments of 10 general Grade 3A hospitals in Hebei Province were randomly divided into experimental group(n=75)and control group(n=75).The control group was given routine treatment,and the experimental group was given ulinastatin 20000 units /(kg ·d),three times intravenously for 30 to 60 minutes.The experimental group was treated for 7days.The APACHE II score,SOFA score,MEDS score and MODS score of the two groups were calculated on the 0th,3rd and 7th day after treatment,and the values of Lac,PCT,CRP,BNP,D-Dimer,CTn I,TBIL and Cr were measured respectively.The time of mechanical ventilation,emergency ICU hospital stay and 28-day mortality were calculated.Results: After 7 days of treatment,the organ function evaluation indexes and laboratory indexes of the two groups were significantly lower than those before treatment(P<0.05),and the APACHE II score,SOFA score and Lac of the test group were significantly lower than those of the control group [APACHE II score(score):10.21±4.49 vs 12.91±5.47,SOFA score(score):1.5(0,4)vs 3(0,7),Lac(mmol/L):1.05±0.46 vs 1.33±0.49].The difference was statistically significant(P<0.05).The MEDS score,MODS score,CRP,D-Dimer,PCT,TBIL,c Tn I,BNP,Cr,mechanical ventilation time,emergency ICU hospitalization time and 28-day mortality in the test group were lower than those in the control group,but there was no significant difference between the two groups(P>0.05).Conclusion: The 28-day mortality rate of patients with severe sepsis and septic shock diagnosed in the emergency room is relatively high,up to 32.7%,while UTI has a certain protective effect on the heart,lung,liver,kidney and other important organ functions of patients,can improve the overall state of patients,reduce the severity of the disease,but failed to significantly shorten the time of mechanical ventilation,emergency ICU hospitalization time and reduce 28-day mortality.