醒脑静注射液联合乌司他丁、连续性肾脏替代治疗对脓毒症合并急性肾损伤患者的疗效、免疫功能及血流动力学的影响

文芳; 司少魁

doi:10.3969/j.issn.1671-2390.2024.01.005

醒脑静注射液联合乌司他丁、连续性肾脏替代治疗对脓毒症合并急性肾损伤患者的疗效、免疫功能及血流动力学的影响

文芳,
司少魁

Impacts of Xingnaojing Injection plus ulinastatin and continuous renal replacement therapy on efficacy, immune function and hemodynamics of septic patients complicated with acute kidney injury

摘要

摘要:
目的探究醒脑静注射液联合乌司他丁、连续性肾脏替代治疗对脓毒症合并急性肾损伤（acute kidney injury，AKI）患者的疗效、免疫功能及血流动力学的影响。
方法选取2019年5月1日至2022年5月31日中国人民解放军联勤保障部队第九八七医院104例脓毒症合并AKI患者，将所有患者按随机数字表法分为观察组（n = 52）、对照组（n = 52）。对照组采用乌司他丁、连续性肾脏替代治疗，观察组在对照组的基础上联合醒脑静注射液进行治疗。采用急性生理与慢性健康（acute physiology and chronic health evaluation，APACHE Ⅱ）评分对生理状态进行评定；采用流式细胞仪检测患者治疗前后T淋巴细胞亚群（CD4⁺、CD8⁺）的水平，并计算CD4⁺/CD8⁺的比值；采用单向免疫扩散法测定患者治疗前后的IgA、IgM和IgG水平；采用电子监护仪监测患者治疗前后中心静脉压（central venous pressure，CVP）、平均动脉压（mean arterial pressure，MAP）以及心率（heart rate，HR）。比较两组患者疗效、APACHE Ⅱ评分、CD4⁺、CD8⁺、CD4⁺/CD8⁺、IgA、IgM、IgG、CVP、MAP及HR水平的变化。
结果观察组患者疗效显著高于对照组（90.39%比73.08%，χ² = 5.216，P = 0.022）；观察组和对照组的APACHE Ⅱ评分（20.57 ± 3.72）分、（19.74 ± 3.51）分比（9.67 ± 2.24）分、（13.84 ± 3.11）分在治疗后显著降低（P＜0.05），治疗后观察组的APACHE Ⅱ评分显著低于对照组（P＜0.05）；观察组和对照组的CD4⁺水平（30.73 ± 6.54）%、（29.46 ± 6.28）%比（35.82 ± 6.59）%、（32.65 ± 6.74）%、CD4⁺/CD8⁺（1.10 ± 0.24）、（1.12 ± 0.26）比（1.84 ± 0.31）、（1.52 ± 0.29）在治疗后均显著增高，CD8⁺水平（27.94 ± 5.75）%、（26.30 ± 5.54）%比（19.48 ± 4.21）%、（21.45 ± 4.54）%显著降低（P＜0.05），治疗后观察组的CD4⁺水平、CD4⁺/CD8⁺均显著高于对照组，CD8⁺水平显著低于对照组（P＜0.05）；观察组和对照组IgA（1.32 ± 0.31）g/L、（1.28 ± 0.29）g/L比（1.96 ± 0.48）g/L、（1.63 ± 0.42）g/L、IgM（0.95 ± 0.31）g/L、（0.91 ± 0.28）g/L比（1.96 ± 0.51）g/L、（1.37 ± 0.36）g/L、IgG（5.82 ± 0.81）g/L、（5.77 ± 0.76）g/L比（9.75 ± 1.43）g/L、（7.32 ± 1.24）g/L水平在治疗后均显著增高（P＜0.05），治疗后观察组IgA、IgM、IgG水平均显著高于对照组（P＜0.05）；观察组和对照组的CVP（6.47 ± 1.24）mmH₂O、（6.42 ± 1.21）mmH₂O比（12.83 ± 2.85）mmH₂O、（9.54 ± 2.32）mmH₂O、MAP（56.53 ± 5.34）mmHg、（55.87 ± 5.21）mmHg比（87.27 ± 6.83）mmHg、（71.92 ± 6.42）mmHg，1 mmHg = 0.133 kPa水平在治疗后均显著增高，HR（117.56 ± 12.65）次/min、（115.73 ± 12.57）次/min比（83.41 ± 8.73）次/min、（98.65 ± 10.51）次/min水平显著降低（P＜0.05），治疗后观察组的CVP、MAP水平均显著高于对照组，HR水平显著低于对照组（P＜0.05）。2组患者尿素氮（10.38 ± 2.31）mmol/L、（10.42 ± 2.34）mmol/L比（14.22 ± 3.34）mmol/L、（19.14 ± 5.27）mmol/L、血肌酐（125.87 ± 26.57）μmol/L、（125.76 ± 25.68）μmol/L比（183.55 ± 36.81）μmol/L、（241.26 ± 42.79）μmol/L水平在治疗后均显著增高（P＜0.05），治疗后观察组的尿素氮、血肌酐水平均显著低于对照组（P＜0.05）。
结论醒脑静注射液联合乌司他丁、连续性肾脏替代治疗脓毒症合并AKI患者的效果较好，可以有效改善患者的免疫功能和血流动力学，缓解患者病情。

Abstract:
Objective To explore the impacts of Xingnaojing Injection plus ulinastatin plus continuous renal replacement therapy （CRRT） on efficacy, immune function and hemodynamics of septic patients complicated with acute kidney injury （AKI）.
Methods From May 1, 2019 to May 31, 2022, 104 septic patients complicated with AKI were selected and randomized into two groups of observation （n = 52） and control （n = 52）. Control group received ulinastatin plus CRRT. And observation group had Xingnaojing injection on the basis of control group. Physiological status was evaluated by APACHE Ⅱ score; the levels of T lymphocyte subsets （CD4⁺/CD8⁺） were measured by flow cytometry before and after treatment and ratio of CD4⁺/CD8⁺ was calculated; the levels of immunoglobulin IgA, IgM and IgG were measured by one-way immunodiffusion before and after treatment; central venous pressure （CVP）, mean arterial pressure （MAP） and heart rate （HR） were monitored with an electronic monitor before and after treatment; in addition, efficacies, changes of APACHE Ⅱ score, CD4⁺ and CD8⁺ levels, CD4⁺/CD8⁺, IgA/M/G, CVP, MAP and HR were compared between two groups.
Results The efficacy of observation group was significantly higher than that of control group （90.39% vs 73.08%, χ²= 5.216, P = 0.022）. APACHE Ⅱ score of observation and control group declined markedly after treatment （20.57 ± 3.72） points, （19.74 ± 3.51） points vs （9.67 ± 2.24） points, （13.84 ± 3.11） points （P＜0.05） and APACHE Ⅱ score of observation group was significantly lower than that of control group after treatment （P＜0.05）. CD4⁺ level （30.73 ± 6.54）%, （29.46 ± 6.28）% vs （35.82 ± 6.59）%, （32.65 ± 6.74）% and CD4⁺/CD8⁺ （1.10 ± 0.24）, （1.12 ± 0.26） vs （1.84±0.31）、（1.52±0.29） spiked obviously after treatment in observation and control groups. CD8⁺ level declined markedly （27.94 ± 5.75）%, （26.30 ± 5.54）% vs （19.48 ± 4.21）%, （21.45 ± 4.54）% （P＜0.05）.After treatment, the levels of CD4⁺ and CD4⁺/CD8⁺ were significantly higher in observation group than those in control group; CD8⁺ level was significantly lower than that in control group （P＜0.05）. The levels of IgA （1.32 ± 0.31） g/L, （1.28 ± 0.29） g/L vs （1.96 ± 0.48） g/L, （1.63 ± 0.42）g/L, IgM （0.95 ± 0.31） g/L, （0.91 ± 0.28） g/L vs （1.96 ± 0.51） g/L, （1.37 ± 0.36） g/L and IgG （5.82 ± 0.81） g/L, （5.77 ± 0.76） g/L vs （9.75 ± 1.43） g/L, （7.32 ± 1.24） g/L in observation and control groups were significant after treatment. After treatment, the levels of IgA, IgM and IgG were significantly higher in observation group than those in control group （P＜0.05）. The levels of CVP （6.47 ± 1.24） mmH₂O, （6.42 ± 1.21） mmH₂O vs （12.83 ± 2.85） mmH₂O, （9.54 ± 2.32） mmH₂O and MAP （56.53 ± 5.34） mmHg, （55.87 ± 5.21） mmHg vs （87.27 ± 6.83） mmHg, （71.92 ± 6.42） mmHg, 1 mmHg = 0.133 kPa spiked markedly in observation and control groups after treatment. HR declined markedly （117.56 ± 12.65） beat/min, （115.73 ± 12.57） beat/min vs （83.41 ± 8.73） beat/min, （98.65 ± 10.51） beat/min （P＜0.05）. After treatment, CVP and MAP levels were significantly higher in observation group than those in control group and HR was significantly lower than that in control group （P＜0.05）. The levels of urea nitrogen （10.38 ± 2.31） mmol/L, （10.42 ± 2.34） mmol/L vs （14.22 ± 3.34） mmol/L, （19.14±5.27） mmol/L and serum creatinine （125.87 ± 26.57） μmol/L, （125.76 ± 25.68） μmol/L vs （183.55 ± 36.81） μmol/L, （241.26 ± 42.79） μmol/L spiked obviously （P＜0.05）. After treatment, the levels of urea nitrogen and blood creatinine were significantly lower in observation group than those in control group （P＜0.05）.
Conclusions Xingnaojing injection combined with ulinastatin and continuous renal replacement therapy are effective in treating patients with sepsis complicated with AKI, which can effectively improve the immune function and hemodynamics of patients, and alleviate the condition of patients.

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