摘要
目的:探讨鼻导管高流量湿化氧疗(HFNC)联合乌司他丁对急诊脓毒症合并呼吸衰竭患者炎症因子水平、氧合指数影响。方法:回顾性分析2023年8月至2025年5月期间收治的86例急诊脓毒症合并呼吸衰竭患者。根据治疗方案分为联合组(43例,接受HFNC联合乌司他丁治疗与常规治疗)和常规组(43例,接受HFNC联合常规治疗)。比较两组治疗前后炎症因子,氧合指数及呼吸功能,免疫内环境与代谢应激标志物,预后转归,不良反应发生率。结果:治疗后,两组患者的转化生长因子-β1(TGF-β1)、白细胞介素-10(IL-10)水平均升高,而高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)、降钙素原(PCT)水平下降(P<0.05)。联合组治疗后TGF-β1、IL-10水平较常规组高,HMGB1、IL-6、PCT水平较常规组低(P<0.05);治疗后,两组患者的氧合指数(PaO2/FiO2)及脉搏血氧饱和度(SpO2)均升高,呼吸频率(RR)下降(P<0.05)。治疗后联合组的PaO2/FiO2、Sp O2较常规组高,RR较常规组低(P<0.05);治疗后,两组患者的CD4+/CD8+T细胞比值均升高,程序性死亡受体-1(PD-1)表达水平和血乳酸值均下降(P<0.05)。组间比较,治疗后联合组的CD4+/CD8+比值高于常规组,而PD-1表达水平和血乳酸水平低于常规组(P<0.05);治疗后,两组序贯器官衰竭估计(SOFA)评分及急性生理与慢性健康评价Ⅱ(APACHEⅡ)评分均较治疗前下降,且联合组低于常规组(P<0.05)。联合组需要接受有创机械通气的患者例数(6例),常规组(14例)。对于需要机械通气的患者,联合组的中位通气时间短于常规组(P<0.05)。此外,联合组的ICU住院时间也显著短于常规组(P<0.05);治疗期间,两组不良反应发生率比较无差异(P>0.05)。结论:HFNC联合乌司他丁可更有效地抑制急诊脓毒症合并呼吸衰竭患者的全身炎症反应,改善氧合功能,改善免疫内环境与代谢应激,降低机械通气需求,缩短ICU住院时间,改善预后,且安全性良好。
Objective:To investigate the effects of high flow nasal cannula humidified oxygen therapy(HFNC)combined with Ulinastatin on the levels of inflammatory factors and oxygen index in emergency sepsis patients with respiratory failure.Method:A retrospective analysis was conducted on the clinical data of 86 emergency sepsis patients with respiratory failure admitted from August 2023 to May 2025.According to the treatment plan,they were divided into a combination group(43 cases,receiving HFNC combined with Ulinastatin treatment and conventional treatment)and a regular group(43 cases,receiving HFNC combined with conventional treatment).Compare the inflammatory factors,oxygen index,respiratory function,immune environment,metabolic stress markers,prognosis,and incidence of adverse reactions between two groups before and Post-treatment.Results:Post-treatment,the levels of transforming growth factor-β1(TGF-β1)and interleukin-10(IL-10)were elevated in both groups,while the levels of high-mobility group protein B1(HMGB1),interleukin-6(IL-6),and procalcitonin(PCT)were decreased(P<0.05).In the combined therapy group,the levels of TGF-β1 and IL-10 were higher than those in the conventional therapy group,whereas the levels of HMGB1,IL-6,and PCT were lower(P<0.05).Post-treatment,both groups showed increased oxygenation indices(PaO2/FiO2)and pulse oximetry saturation(SpO2).along with decreased respiratory rate(RR)(P<0.05).In the combination group,the PaO2/FiO2 and SpO2 levels were higher than those in the regular group,and the RR was lower than that in the regular group(P<0.05).Post-treatment,the CD4+/CD8+T cell ratio was elevated in both groups,and the expression levels of programmed death receptor-1(PD-1)and blood lactate levels were decreased(P<0.05).Compared between groups,the CD4+/CD8+ratio in the combination group was higher than that in the regular group,while the PD-1 expression levels and blood lactate levels were lower than those in the regular group(p<0.05).Post-treatment,the sequential organ failure assessment(SOFA)score and the acute physical and chronic health evaluation II(APACHE II)score were both decreased compared to pre-treatment levels,and the combination group showed lower scores than the regular group(p<0.05).The number of patients requiring invasive mechanical ventilation was 6 in the combination group and 14 in the regular group.For patients requiring mechanical ventilation,the median ventilation time in the combination group was shorter than that in the regular group(p<0.05).Furthermore,the ICU stay duration in the combined group was shorter than that in the regular group(P<0.05).During treatment,there was no difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:The combination of HFNC and Ulinastatin can more effectively inhibit systemic inflammatory response,improve oxygenation function,enhance immune microenvironment and metabolic stress,reduce the need for mechanical ventilation,shorten ICU stay,improve prognosis,and have good safety in emergency sepsis patients with respiratory failure.
作者
孙瑾
谭思嘉
李玉玉
徐亮
丁玉雪
SUN Jin;TAN Si-jia;LI Yu-yu;XU Liang;DING Yu-xue(Emergency Department,Xuzhou Central Hospital affiliated with Southeast University,Xuzhou,Jiangsu,221000,China;Respiratory Department,Xuzhou Central Hospital affiliated with Southeast University,Xuzhou,Jiangsu,221000,China)
出处
《现代生物医学进展》
2026年第5期686-693,共8页
Progress in Modern Biomedicine
基金
江苏省自然科学基金项目(22-5032)。
关键词
鼻导管高流量湿化氧疗
乌司他丁
脓毒症
呼吸衰竭
炎症因子
氧合指数
Nasal cannula high flow humidified oxygen therapy
Ulinastatin
Sepsis
Respiratory failure
Inflammatory factors
Oxygen index
