| Background: Currently the infection in ICU is major cause of systemic inflammatory response, which is the most threatening complication in a certain stage of sepsis, especially for infection shock. It has a high fatality rate and is a big threat to health. It has become the primary cause of death in critical ill patients. Although, in recent years, more and more new treatments emerge, it does not decrease mortality significantly from septic shock relating to the excessive release of inflammatory mediators, which may cause inhabitation of immune function. The key to treat severe sepsis successfully is to inhibit the release of inflammatory mediators and effectively eliminate inflammatory mediators. CRRT can effectively remove inflammatory mediators, regulate leukocyte reactivity, and further reduce inflammation; UTI can inhibit the activity of a variety of enzymes to inhibit the excessive release of inflammatory mediators. This study has observed the clinical effect of the treatment ulinastatin combined with CRRT in patients with septic shock, and has tried to explore the possible mechanism of action, and provide a theoretical basis for treatment of septic shock with ulinastatin and CRRT together.Object:To discussion the value of ulinastatin combined with CRRT in treatment of septic shock infection.Method: We select 60 patients with sepsis in our hospital from October 2013 to October 2014, with signed informed consent. By random, the volunteers was divided into group A(receiving conventional treatment),Group B(treated with conventional therapy plus blood purification therapy)、Group C(receiving conventional treatment plus ulinastatin combining blood purification therapy);Treatment:1、Ulinastatin 500,000 units plus into 0.9 % sodium chloride configured to 50 ml, per milliliter contains ulinastatin 10,000 units,20,000 units / hour intravenous infusion;2、CRRT treatment:Using CVVH mode,dose 35ml/kg/h,on the basis of conventional therapy,we use the two methods above separately. We have recorded necessary parameters, including APACHII score, SOFA score, oxygenation index, lactate, the use of vasoactive agent, WBC、PCT、CRP,IL-10、IL-6、TNF-a of all the patients at the beginning and on a basis of 72 hours and the seventh day regularly. Also The mortality has been recorded. Based on the data, we have analysized the datato, and compared all the three groups. All of the data were analyzed using SPSS18.0 software package. P <0.05, the result is positive.Effect:All the three groups of critical ill patients, the condition and clinical data have no significant difference. In CRRT group and uinastatin jointing CRRT group, the hemodynamics and various inflammatory mediators indicators have shown a good sign(P <0.05), better than the group receiving the conventional therapy only. Especially for the UTI group, the result(P <0.05) is better than the simple application of CRRT treatment group. After one week of treatment, 12 cases receiving conventional therapy only died; 8 cases died in CRRT group; 6 cases died in the combination therapy group. Talking mortality only, the performance of CRRT group and combined treatment group is significantly better than that of the conventional therapy group(P <0.05). CRRT group, comparing to the combined group, there is no big difference(P> 0.05), while the combined group has a lower mortality rate.Conclusion: Ulinastatin combining continuous renal replacement therapy(CRRT) can significantly improve hemodynamics in treatment of septic shock, improve tissue hypoperfusion, improve oxygenation index, stable the remain environment, stablize blood pressure, reduce the amount of vasoactive drug, and further reduce the mortality of septic shock. It is concluded that the mothod of ulinastatin combining CRRT is an effective treatment for septic shock. |
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