Effects Of Ulinastatin On Pulmonary Vascular Permeability And Protective Mechanism Of Vascular Endothelial Glycocalyx In Patients With Septic Shock

Background:1?Vascular permeability in septic shock reflects not only the severity of the disease and the inflammatory response,but also the quality of the resuscitation.As is known to us all,Ulinastatin is a broad-spectrum enzyme inhibitor of various functions in anti-inflammation,immunoregulation,anti-coagulation and oxidative stress.Also,its potential effect on alleviting vascular permeability in patients with septic shock can be found through careful observation.However,there are few studies about the mechanism of ulinastatin on the regulation of vascular permeability and potential resuscitation in septic shock.2?The endothelial glycocalyx plays an important role in regulating the function of endothelial cell.As the first line of defense to maintain vascular permeability,glycocalyx is easy to be attacked by inflammation,then stimulates and developes a variety of pathological conditions.Therefore,changes in the glycocalyx may reflect the extent of endothelial dysfunction.Still,the relationship between vascular permeability changes and glycocalyx changes in septic shock remains unclear.Materials and Methods:1?The study enrolled 50 cases of septic shock patients in ICU and emergency department of Daping Hospital from January 2014 to Octoble 2016.According to whether using ulinastatin or not,all patients were divided into Ulinastatin group(25 cases)and the control group(25 cases).Basic information,APACHE ?score,SOFA score,biochemical indicators reflect the various organ function,PICCO parameters,inflammatory parameters,lactic acid,and the amount of fluid resuscitation were collected and analyzed before treatment and 24 hours later on all patients.2?19 cases of septic shock patients in ICU of 1st affiliated hospital of Chongqing Medical University and 2 cases of septic shock patients in ICU of Daping Hospital from January 2014 to Octoble 2016 were enrolled.Basic information,APACHE ? score,SOFA score,PICCO parameters,lactic acid,biochemical indicators reflect the various organ function and inflammatory parameters as well as 28 days mortality were collected.5ml of peripheral vein blood was collected to detect the amount of HS,HSPE and syndecan-1 in the serum by ELISA.Dividing the patients into two groups according to the EVLWI,EVLWI < 8ml/kg as the control group,EVLWI ? 8ml/kg as the lung water group.To compare the changes of glycocalyx,and to analyze the relationship between glycocalyx with clinical parameters and prognosis.Results:1.When Ulinastatin group was compared with the control group,the PVPI,EVLWI,oxygenation and lac in the Ulinastatin group were significantly superior to those in the control group.Furthermore,colloid fluid requirements were significantly less in Ulinastatin group than those in the control group,of which albumin requirements reduced significantly,too.2.The lung water group compared with the control group in the patients with septic shock there was a significant difference in glycocalyx degradation in products HS.3.In the lung water group HS was higher,and EVLWI has positive correlation with HS,while EVLWI increased in septic shock patients,HS also increased.4.The blood concentration of HSPE,HS and Sydecan-1 in septic shock patients was positively related to each other,and the changes were consistent.5.When the lung water group was compared with the control group,the INR and PT in the lung water group were significantly superior to those in the control group,and positively correlated with HS respectively.With the increase of HS,INR and PT increased correspondingly.6.When the lung water group was compared with the control group,the Lac in lung water group was significantly superior to those in the control group.7.When the lung water group was compared with the control group,the SOFA score in the lung water group was significantly superior to those in the control group.The SOFA score is positively related to HS,the higher the HS,the higher the SOFA score.Conclusions:1?In patients with septic shock,vascular permeability is closely related to the quality and effectiveness of resuscitation.2?The change of glycocalyx in patients with septic shock is closely related to the severity of the disease.It may affect the prognosis of patients with sep tic shock by regulating the permeability of blood vessels and coagulation function.3 ? Ulinastatin has the explicit effects on improving the quality and e ffects of resuscitation in patients with septic shock by ameliorating perfusion and tissue oxygenation,and colloid requirements are reduced after Ulinastatin admistration,which are associated with reducing vascular permeability and extravascular lung water.