本文選題：烏司他丁　切入點(diǎn)：膿毒癥　出處：《大連醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)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(yīng)綜合征(SIRS),是嚴(yán)重創(chuàng)傷、燒傷、休克、外科大手術(shù)后等危重患者的常見(jiàn)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(yán)重膿毒癥是指膿毒癥的基礎(chǔ)上伴有器官功能障礙、組織灌注不足(乳酸酸中毒、少尿、意識(shí)改變等)以及低血壓。膿毒性休克是指嚴(yán)重膿毒癥伴經(jīng)液體復(fù)蘇仍難以逆轉(zhuǎn)的組織低灌注狀態(tài),表現(xiàn)為經(jīng)過(guò)最初的液體復(fù)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(hù)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(guó)內(nèi)一項(xiàng)多中心流行病學(xué)調(diào)查顯示,嚴(yán)重膿毒癥在ICU的發(fā)病率為8.68%,死亡率高達(dá)44.7%,且通常消耗醫(yī)療費(fèi)用極高,給患者身體上、心理上和經(jīng)濟(jì)上帶來(lái)極大負(fù)擔(dān)。在美國(guó),每年有21.5萬(wàn)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(chǔ)疾病的患者中死亡率超過(guò)70%。目的評(píng)價(jià)烏司他丁注射液治療膿毒癥的有效性及安全性。方法應(yīng)用Revman 5.0軟件對(duì)烏司他丁注射液治療膿毒癥的隨機(jī)對(duì)照試驗(yàn)(RCT)進(jìn)行系統(tǒng)評(píng)價(jià)。計(jì)算機(jī)檢索外文數(shù)據(jù)庫(kù)Pubmed(2000-至今),Ovid(2000-至今),Elsevier(2000-至今)及CBM、VIP、CNKI,篩選相關(guān)文獻(xiàn)。結(jié)果共納入13個(gè)RCT試驗(yàn),共736例患者,烏司他丁組(試驗(yàn)組)370例,對(duì)照組366例。Meta分析結(jié)果表明,試驗(yàn)組腫瘤壞死因子-α(TNF-α)、白介素-6(IL-6)、白細(xì)胞(WBC)、C-反應(yīng)蛋白(CRP)及APACHEⅡ評(píng)分等研究與對(duì)照組相比均有明顯差異性,總體顯示有益的變化,個(gè)別實(shí)驗(yàn)組無(wú)差異。沒(méi)有不良反應(yīng)的記錄。結(jié)論烏司他丁治療膿毒癥相對(duì)安全,并在改善患者預(yù)后、相關(guān)指標(biāo)上具有一定優(yōu)勢(shì),但高質(zhì)量的研究仍較少,且缺乏大規(guī)模臨床實(shí)驗(yàn)論證,尚無(wú)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(guān)實(shí)驗(yàn)研究,應(yīng)克服當(dāng)前研究的局限性,增加納入例數(shù),改進(jìn)設(shè)計(jì),采用更客觀、更受認(rèn)可、更具有指向性的終點(diǎn)療效指標(biāo)。納入研究的方法學(xué)質(zhì)量評(píng)價(jià)尚可,但所應(yīng)用的評(píng)價(jià)指標(biāo)對(duì)結(jié)果的評(píng)價(jià)有限,有必要進(jìn)行全面隨即雙盲臨床試驗(yàn)進(jìn)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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