CAJ | 학술논문

目的评估肌苷对严重脓毒症患者的临床疗效.方法采用前瞻性研究方法,选择本院2011年3月至2012年8月入住重症监护病房(ICU)的85例严重脓毒症患者,按简单随机化法分为3组.常规治疗组25例按严重脓毒症诊疗常规治疗；6h内肌苷治疗组28例,6h后肌苷治疗组32例,两组均在常规治疗基础上,每日应用肌苷1200 mg(分2次静脉滴注,每次600 mg,连用14d).治疗前后取患者静脉血,检测血浆炎症因子水平及重要器官功能指标,统计各组住ICU天数及病死率.结果与常规治疗组相比,6h内和6h后肌苷治疗组治疗后血浆促炎因子肿瘤坏死因子-α(TNF-α)、白细胞介素(IL-6)、C-反应蛋白(CRP)水平下降更明显[TNF-α(ng/L):9.6±4.1、10.8±2.8比18.2±3.3,IL-6(ng/L):123.0±10.1、132.0±18.4比172.0±17.9,CRP(mg/L):42.0±10.3、45.0±8.6比61.0±12.7,均P＜ 0.05],IL-10无明显差异(ng/L:53.0±9.4、56.0±10.8比58.0±11.2,均P＞0.05)；丙氨酸转氨酶(ALT)、总胆红素、B型脑钠肽(BNP)、氧合指数等器官功能指标改善也更为明显[ALT(U/L):42.0±10.8、46.0±7.9比63.0±9.4,总胆红素(μmol/L):16.3±6.7、18.3±7.3比28.1±8.5,BNP(ng/L):322.0±28.7、347.0±31.4比428.0±43.2,氧合指数(mm Hg,1 mm Hg=0.133 kPa):210.0±23.8、198.0±21.4比163.0±15.2,均P＜0.05],2个肌苷治疗组间比较差异无统计学意义(均P＞0.05).常规治疗组、6h内和6h后肌苷治疗组间住ICU天数(d:22.4±6.3、19.8±4.6、23.1±5.2)和病死率(36.0％、32.1％、34.4％)大致相当,两两比较差异均无统计学意义(均P＞0.05).结论严重脓毒症患者治疗中加用常规剂量肌苷,可降低血浆炎症因子水平,促进器官功能恢复,但未能减少患者住ICU天数,也未能降低病死率.
목적 평고기감대엄중농독증환자적림상료효.방법 채용전첨성연구방법,선택본원2011년3월지2012년8월입주중증감호병방(ICU)적85례엄중농독증환자,안간단수궤화법분위3조.상규치료조25례안엄중농독증진료상규치료；6h내기감치료조28례,6h후기감치료조32례,량조균재상규치료기출상,매일응용기감1200 mg(분2차정맥적주,매차600 mg,련용14d).치료전후취환자정맥혈,검측혈장염증인자수평급중요기관공능지표,통계각조주ICU천수급병사솔.결과 여상규치료조상비,6h내화6h후기감치료조치료후혈장촉염인자종류배사인자-α(TNF-α)、백세포개소(IL-6)、C-반응단백(CRP)수평하강경명현[TNF-α(ng/L):9.6±4.1、10.8±2.8비18.2±3.3,IL-6(ng/L):123.0±10.1、132.0±18.4비172.0±17.9,CRP(mg/L):42.0±10.3、45.0±8.6비61.0±12.7,균P＜ 0.05],IL-10무명현차이(ng/L:53.0±9.4、56.0±10.8비58.0±11.2,균P＞0.05)；병안산전안매(ALT)、총담홍소、B형뇌납태(BNP)、양합지수등기관공능지표개선야경위명현[ALT(U/L):42.0±10.8、46.0±7.9비63.0±9.4,총담홍소(μmol/L):16.3±6.7、18.3±7.3비28.1±8.5,BNP(ng/L):322.0±28.7、347.0±31.4비428.0±43.2,양합지수(mm Hg,1 mm Hg=0.133 kPa):210.0±23.8、198.0±21.4비163.0±15.2,균P＜0.05],2개기감치료조간비교차이무통계학의의(균P＞0.05).상규치료조、6h내화6h후기감치료조간주ICU천수(d:22.4±6.3、19.8±4.6、23.1±5.2)화병사솔(36.0％、32.1％、34.4％)대치상당,량량비교차이균무통계학의의(균P＞0.05).결론 엄중농독증환자치료중가용상규제량기감,가강저혈장염증인자수평,촉진기관공능회복,단미능감소환자주ICU천수,야미능강저병사솔.
Objective To evaluate the therapeutic effect of inosine in patients with severe sepsis.Methods A prospective study was conducted.Eighty-five severe sepsis patients hospitalized in intensive care unit (ICU) from March 2011 to August 2012 were included and randomized into three groups:25 cases as conventional therapy group,who were treated with routine treatments; 28 patients were given inosine within 6 hours besides routine treatments; 32 patients were given inosine after 6 hours together with routine treatments.Inosine was given in the latter two groups by intravenous infusion (600 mg twice a day) for 10-14 days or to the end of the research when patients died or discharged from ICU.Before or after the treatment,venous blood was collected for determination of pro-inflammatory factors and organ function parameters.Average duration of stay in ICU and mortality rate were analyzed.Results Compared with conventional therapy group,the levels of pro-inflammatory factors,such as tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),and C-reactive protein (CRP) were decreased in inosine in both within 6-hour and after 6-hour groups [TNF-α (ng/L):9.6 ± 4.1,10.8 ± 2.8 vs.18.2 ± 3.3,IL-6 (ng/L):123.0 ± 10.1,132.0 ± 18.4 vs.172.0 ±17.9,CRP (mg/L):42.0 ± 10.3,45.0 ± 8.6 vs.61.0 ± 12.7,all P＜0.05],but there was no statistical significance in the content of IL-10 (ng/L:53.0 ±9.4,56.0 ± 10.8 vs.58.0 ± 11.2,both P＞0.05).The lowering of alanine transaminase (ALT),total bilirubin,B-type natriuretic peptide (BNP),oxygenation index was more marked in inosine within 6-hour and after 6-hour groups than those of conventional therapy group [ALT (U/L):42.0 ± 10.8,46.0 ± 7.9 vs.63.0 ± 9.4,total bilirubin (μmol/L):16.3 ± 6.7,18.3 ± 7.3 vs.28.1 ± 8.5,BNP (ng/L):322.0 ± 28.7,347.0 ± 31.4 vs.428.0 ± 43.2,oxygenation index (mm Hg,1 mm Hg=0.133 kPa):210.0 ± 23.8,198.0 ± 21.4 vs.163.0 ± 15.2,all P＜0.05].However,the difference of these values showed no significant difference between the two inosine groups (all P＞0.05).There was no statistical significance in ICU stay days (days:22.4 ±6.3,19.8 ±4.6,23.1 ±5.2) and mortality rate (36.0％,32.1％,34.4％) among three groups (all P＞ 0.05).Conclusion For severe sepsis patients,on the base of routine treatments,normal dose of inosine can lower the level of pro-inflammatory factors and ameliorate organ function,but it cannot decrease average ICU stay days and mortality rate.