A clinical study of ulinastatin combining with continuous blood purification in the treatment of patients with multiple organ dysfunction syndrome / 中华急诊医学杂志

ABSTRACT

Objective To observe the clinical efficacy of ulinastatin(UT) conjoined to high flow continuous blood purification( CBP) in the critical patients with multiple organ dysfunction syndrome(MODS). To evaluate the therapeutic potential of UT and CBP in systemic inflammatory response syndrome (SIRS) , severe sepsis( SS) , acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Method A total of 122 cases of emergency and critical patients with a score of more than 15 counted up from APACHE H (acute physiology and chronic health evaluation 11 ) were randomly divided into Ulinastatin treatment group (UT group, n = 35) .continuous blood pu-rification(CBP group, n = 31),UT plus CBP (combine group, n = 30) and routine treatment group (control group, n =26). Routine treatment was given to patients of all groups, and patients of UT group had Ulinastatin 0.4 MIU given intravenously every 8 hours for 7 days in addition. Patients of CBP group were managed with continuous blood purification round the clock for 7 days and those of combine group were treated with UT plus CBP for 7 days.The efficacy of the treatment in four groups was assessed,and serum high sensivity reactive protein(hs-CRP) and IL-6 levels were measured on admission and comparison was made between values of biomarkers taken before and 1 d,3 d,and 7 d after treatment in four groups. The changes in WBCs,arterial gas analysis and the oxygena-tion index PaO2/FiO2 were checked, and at the same time, the APACHE II values and the incidence of MODS were compared within four groups. Results (1)One, three and seven days after treatment the plasma hs-CRP and IL-6 levels in UT and CBP groups were reduced significantly more than those in control group ( P < 0. 05), and in combine groups those were more dramatically lowered ( P < 0.05, P < 0.01). Before treatment there was no significance diffience in those values between groups, and there was on diffience in those values between 3 rd day and 7 th day after treatment ( P > 0.05). (2) The 1 st,3 rd and 7 th day after treatment the arterial gas PaO2/FiO2 index in UT and CBP groups was improved more than that in control group ( P < 0.05) , and it in combine group was most significant improved (P < 0.05,P < 0.01). The ALT and creatinine were lower than those in control group ( P < 0.05), and there were no significant differences in ALT and creatinine between groups before treatment (P > 0.05). (3) The 1 st,3 rd and 7th day afer treatment,the APACHE II values in UT and CBP groups were decreased more than those in control group ( P < 0. 05) , and therefore, the incidence of MODS was lower ( P < 0.05). Conclusions Ulinastatin could significantly inhibit the production of inflammatory cytokines and CBP could effectively eliminate inflammatory factors from blood, and the combination of these two approaches produce a more effective therapeutic potential for preventing MODS development.