發(fā)布時間：2018-03-14 13:25

  本文選題：烏司他丁　切入點：膿毒癥　出處：《大連醫(yī)科大學》2015年碩士論文　論文類型：學位論文

【摘要】：研究背景膿毒癥即指感染所致的全身性炎癥反應綜合征(SIRS),是嚴重創(chuàng)傷、燒傷、休克、外科大手術后等危重患者的常見并發(fā)癥,也是誘發(fā)休克、多器官功能不全甚至衰竭的重要原因。嚴重膿毒癥是指膿毒癥的基礎上伴有器官功能障礙、組織灌注不足(乳酸酸中毒、少尿、意識改變等)以及低血壓。膿毒性休克是指嚴重膿毒癥伴經(jīng)液體復蘇仍難以逆轉的組織低灌注狀態(tài),表現(xiàn)為經(jīng)過最初的液體復蘇后持續(xù)低血壓或血乳酸濃度升高。膿毒癥的發(fā)生率和病死率極高,是重癥監(jiān)護病房(ICU)患者的主要死亡原因之一,目前已成為人類十大死因之一。國內一項多中心流行病學調查顯示,嚴重膿毒癥在ICU的發(fā)病率為8.68%,死亡率高達44.7%,且通常消耗醫(yī)療費用極高,給患者身體上、心理上和經(jīng)濟上帶來極大負擔。在美國,每年有21.5萬人死于膿毒癥及其后續(xù)并發(fā)癥。ICU中膿毒癥總死亡率約30-40%,而在老年或伴有基礎疾病的患者中死亡率超過70%。目的評價烏司他丁注射液治療膿毒癥的有效性及安全性。方法應用Revman 5.0軟件對烏司他丁注射液治療膿毒癥的隨機對照試驗(RCT)進行系統(tǒng)評價。計算機檢索外文數(shù)據(jù)庫Pubmed(2000-至今),Ovid(2000-至今),Elsevier(2000-至今)及CBM、VIP、CNKI,篩選相關文獻。結果共納入13個RCT試驗,共736例患者,烏司他丁組(試驗組)370例,對照組366例。Meta分析結果表明,試驗組腫瘤壞死因子-α(TNF-α)、白介素-6(IL-6)、白細胞(WBC)、C-反應蛋白(CRP)及APACHEⅡ評分等研究與對照組相比均有明顯差異性,總體顯示有益的變化,個別實驗組無差異。沒有不良反應的記錄。結論烏司他丁治療膿毒癥相對安全,并在改善患者預后、相關指標上具有一定優(yōu)勢,但高質量的研究仍較少,且缺乏大規(guī)模臨床實驗論證,尚無可靠、充分的證據(jù)表明烏司他丁治療膿毒癥安全、有效。今后開展相關實驗研究,應克服當前研究的局限性,增加納入例數(shù),改進設計,采用更客觀、更受認可、更具有指向性的終點療效指標。納入研究的方法學質量評價尚可,但所應用的評價指標對結果的評價有限,有必要進行全面隨即雙盲臨床試驗進行論證。
[Abstract]:Background sepsis refers to the systemic inflammatory response syndrome caused by infection. It is a common complication of severe trauma, burn, shock, major surgery and other critical patients, and it is also a kind of induced shock. Severe sepsis refers to severe sepsis with organ dysfunction and insufficient tissue perfusion (lactic acidosis oliguria). Septic shock is a state of tissue hypoperfusion that is difficult to reverse in severe sepsis with fluid resuscitation. After initial fluid resuscitation, continuous hypotension or elevated blood lactate concentration. Sepsis is one of the leading causes of death in ICU patients with high incidence and mortality of sepsis. At present, it has become one of the top ten causes of death in human beings. A multi-center epidemiological survey in China shows that the incidence of severe sepsis in ICU is 8.68, the mortality rate is as high as 44.7, and the cost of medical treatment is usually extremely high. Psychological and economic burdens. In the United States, 215,000 people die each year from sepsis and its complications. The total mortality rate of sepsis in ICU is about 30-400.The mortality rate in elderly patients or patients with underlying diseases is more than 70.ObjectiveTo evaluate the efficacy of ulinastatin injection in the treatment of sepsis. Methods Revman 5.0 software was used to evaluate the randomized controlled trial of ulinastatin injection in the treatment of sepsis. Results A total of 13 RCT trials were conducted. There were 736 patients in Ulinastatin group (370 cases in the trial group and 366 cases in the control group). The results of Meta-analysis showed that there were significant differences between the study group and the control group in the study of tumor necrosis factor- 偽 TNF- 偽, interleukin-6 (IL-6), WBCC-reactive protein (APACHE) and APACHE 鈪，

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