The Effect Of Ulinastatin On Intestinal Barrier Dysfunction In Elderly Patients With Severe Disease

Because immune function of elderly patients is in decline stage,and their gut barrier function also begins to deteriorate.When suffering from acute and critical illness,such as severe infection,large trauma and major operation,it often leads to intestinal barrier function damage.How to prevent and control the intestinal barrier dysfunction is a major problem facing the clinic.Ulinastatin has a broad spectrum of inhibitory effects on many proteases,and can prevent the release of inflammatory factors caused by various factors.It also has a protective effect on many organs,and has been widely used in clinical treatment.But at present,the clinical evidence of ulinastatin for the treatment of intestinal dysfunction in elderly patients with severe disease is still lacking.?Objective? To investigate the effect of ulinastatin on intestinal barrier function and prognosis in elderly patients with severe intestinal barrier dysfunction.?Methods? Select the intestinal barrier function disorder admitted to our ICU from May 2016-February 2017.According to the random number table method,patients were divided in two groups: study group(25 cases)and control group(25 cases).During the treatment,the control group was given the routine treatment,such as the positive correction of the etiology,the advanced life support,the strengthening of anti-infection,the correction of the internal environment disorder,the nutritional support and so on.The study group was given ulinastatin on the basis of routine treatment.Blood samples of the patients were obtained for detection of PCT,BT,DAO,D-lac levels at days 0,1,2,3,7(D0,D1,D2,D3,D7)after admission,using enzyme method to detect the levels of PCT,BT,DAO,and Dlactate.While patients' APACHE II scores,SOFA scores,length of ICU stay and 28 d mortality also be recorded at the same time.?Results?Before treatment,the patients' demographics and clinical characteristics : APACHE II scores,SOFA scores,the values of PCT,BT,DAO,and D-Lac in plasma were no difference in the two groups(P>0.05).After treatment,the scores of APACHE II and SOFA were decreased in both groups of the two groups.But APACHE score and SOFA score of the study group decreased more significantly than those in the control group.At the D3 and D7 observation points,the APACHE II scores in the study group were significantly lower than those in the control group,and the SOFA scores in the observation group at D2,D3 and D7 were significantly lower than those in the control group(P < 0.05).In addition,the PCT level of the two groups showed a decreasing trend as the treatment progressively,but the downward trend of the study group was more obvious.At the D2 and D3 observation points,the PCT level of the study group was significantly lower than that of the control group(P < 0.05).At the same time,the serum BT,DAO and D-Lac levels of the two groups decreased along with the progress of treatment,but the downward trend of the study group were more obvious.After treatment,the BT level of the study group was significantly lower than that of the control group.At D2,D3 and D7 observation points,the DAO level in the study group was significantly lower than that in the control group.At the observation point of D3 and D7,the D-Lac level in the study group was significantly lower than that in the control group(P < 0.05).There were positive correlations in the scores APACHE and SOFA,hospitalization time and the level of PCT with the level of BT?DAO,D-Lac(P < 0.05).The time of hospitalization in the study group was significantly lower than that of the control group(P < 0.05),but there was no significant difference in the mortality rate between the two groups(P>0.05).?Conclusion?(1)Ulinastatin can shortens the patient's hospitalization time,but has no significant effect on reducing the mortality of 28 d.(2)Ulinastatin can reduce the early inflammatory response and reduced the level of endotoxin in the patients with intestinal barrier dysfunction.