CAJ | 학술논문

目的：探讨大剂量乌司他丁（ Ulinastatin ）对感染性休克患者的临床疗效。方法：50例感染性休克患者被随机分为常规剂量乌司他丁对照组25例和大剂量乌司他丁治疗组25例。常规对照组20万U/次乌司他丁静脉推注，2次/d；大剂量治疗组每次100万U静脉推注，1次/h，5次/d，共500万U静脉推注，次日开始进行常规治疗，20万U/次，2次/d。观测两组治疗5d后APACHEII 评分、丙氨酸氨基转移酶（ ALT）、天门冬氨酸氨基转氨酶（ AST ）及血乳酸（ Lac ）的变化情况；两组患者用药后1h、4h、12h、1d及3d的尿量、心率（HR）、收缩压（SP）；记录患者休克恢复时间、病情稳定所需时间及住ICU天数等。结果：①两组治疗5d后，大剂量治疗组APACHEII评分、ALT、AST、Lac各指标值均低于常规对照组。②大剂量治疗组用药后1h、4h、12h、1d、3d的尿量的检测值均高于常规对照组；大剂量治疗组用药后1h、4h、12h、1d、3d的HR 检测值均低于常规对照组；大剂量治疗组用药后1h、4h、12h、1d、3d的SP检测值均低于常规对照组。③大剂量组休克恢复时间明显短于常规对照组；大剂量组住ICU天数明显少于常规对照组。④病死率：常规组死亡17人，病死率68％，大剂量组死亡9人，病死率36％。结论：大剂量乌司他可缩短休克恢复时间及病情稳定所需时间；降低患者病死率，促进感染性休克患者的病情的控制，改善预后。
목적：탐토대제량오사타정（ Ulinastatin ）대감염성휴극환자적림상료효。방법：50례감염성휴극환자피수궤분위상규제량오사타정대조조25례화대제량오사타정치료조25례。상규대조조20만U/차오사타정정맥추주，2차/d；대제량치료조매차100만U정맥추주，1차/h，5차/d，공500만U정맥추주，차일개시진행상규치료，20만U/차，2차/d。관측량조치료5d후APACHEII 평분、병안산안기전이매（ ALT）、천문동안산안기전안매（ AST ）급혈유산（ Lac ）적변화정황；량조환자용약후1h、4h、12h、1d급3d적뇨량、심솔（HR）、수축압（SP）；기록환자휴극회복시간、병정은정소수시간급주ICU천수등。결과：①량조치료5d후，대제량치료조APACHEII평분、ALT、AST、Lac각지표치균저우상규대조조。②대제량치료조용약후1h、4h、12h、1d、3d적뇨량적검측치균고우상규대조조；대제량치료조용약후1h、4h、12h、1d、3d적HR 검측치균저우상규대조조；대제량치료조용약후1h、4h、12h、1d、3d적SP검측치균저우상규대조조。③대제량조휴극회복시간명현단우상규대조조；대제량조주ICU천수명현소우상규대조조。④병사솔：상규조사망17인，병사솔68％，대제량조사망9인，병사솔36％。결론：대제량오사타가축단휴극회복시간급병정은정소수시간；강저환자병사솔，촉진감염성휴극환자적병정적공제，개선예후。
Objective: To explore clinical efficacy of high doses ulinastatin on patients with septic shock.Method: 50 patients with septic shock were randomly divided into conventional doses ulinastatin group (conventional-dose group, 25 cases) and high doses ulinastatin group (high doses group, 25 cases). Conventional-dose group were intravenously injected 200, 000 U of ulinastatin every time , twice a day. While the high doses group were cured one million U for half an hour by rapid intravenous injection , 5 mil-lion unit ulinastatin within 5 hours.Routine treatment were carried out the next day , 200 000 unit each time, twice a day.APACHEII ratings score, serum ALT, AST and lactic acid content were measured after treat-ment.The urine output , heart rate and systolic blood pressure of 1h, 4h, 12h, 1d and 3d in two groups were measured after treatment .Recorded the time of shock recovery , the hospitalization days and the time return to a stable condition .Result:①After treatment for 5 days, the APACHEII score , ALT, AST, Lac each index values in high-dose treatment group were lower than those of conventional control group;②The urine output detection value of 1h, 4h, 12h, one day, 3 days in high-dose treatment group were all higher than those of the normal control group after dosing; The heart rate detection value of 1h, 4h, 12h, one day, 3 days in high-dose treatment group were all lower than those of the normal control group by using drugs ;The systolic blood pressure detection value of 1h, 4h, 12h, one day, 3 days in high-dose treatment group were all higher than those of the normal control group after medication .③The shock recovery time of high-dose treatment group was significantly shorter than normal control one; The hospitalization days in intensive care unit was obviously less than normal control one .④The mortality:17 cases died in the conventional group , the fatality rate was 68 percent;nine cases died in the high-dose treatment group , the fatality rate was 36 percent .Con-clusion:High doses ulinastatin has resistance to shock , can shorten the time of shock recovery , the hospital-ization days and the time return to a stable condition .It can reduce mortality and complications , can alleviate the condition of patients with septic shock , improve prognosis .