The Effect And Clinical Value Of Ulinastatin In Early Immune Inflammation Responses Of Patients With Severe Multiple Trauma

Objectives:To investigate the effects and clinical value of ulinastatin in early inflammatory and immune responses of patients with severe multiple trauma.The changes of T lymphocyte subsets in immune system and early inflammatory related indicators were mainly researched objects.Subsequently,the clinical value,related complications and clinical prognosis were analyzed.Methods:The Department of Trauma Rescue,First Affiliated Hospital of the Army Military Medical University,admitted 40 patients with severe multiple injuries(from ISS score>16)from January 2016 to January 2019,aged 16-65(45.1±8.7)years old,25 males and 15females,which were selected.Injury factors:18 cases of traffic accidents,12 cases of high fall injuries,5 cases of heavy body bruises,3 cases of machine crush injuries,and 2 other cases.Types of injury:21 cases of chest and abdomen combined injury,7 cases of abdominal injury,5 cases of chest injury,7 cases of pelvis and multiple extremities,and ISS score of(23.9±6.7)points.Forty patients with severve multiple-trauma were randomly divided into ulinastatin group and non-ulinastatin group.In the conventional treatment based on,ulinastatin treatment group of the patients received intravenous infusion of ulinastatin,100 kU,three daily for seven days.Non-ulinastatin group of the patients only received routine treatment.Routine treatment includes:anti-infective treatment,rational application of antibiotics under the guidance of bacterial culture,correction of water and electrolytes,acid-base balance disorders,and intravenous nutritional support treatment.All patients were collected elbow venous blood by the same physician at 8:00 a.m.The counts of T lymphocyte subsets(CD3~+?CD4~+?and CD8~+),ratio of CD4~+/CD8~+,and other inflammatory related indicators white blood cell count(WBC,×10~9/L),C-reactive protein(CRP,mg/L),procalcitonin(PCT,ng/mL),tumor necrosis factor alpha(TNF-?,pg/mL),interleukin-6(IL-6,pg/mL)were measured and compared before treatment,on days1,3 and 7 after treatment,respectively.Clinical relevant indicators were observed and compared before and after the treatment in the two groups,which have liver function alanine aminotransferase(ALT,U/L),renal function urea nitrogen(BUN,mmol/L),creatinine value Scr(mol/L),endocrine hormone levels cortisol(nmol/L)Content,as well as clinical secondary related indicators:the average length of hospital stay(d),ICU time(d),complications(sepsis,stress ulcer,MODS,etc.)incidence rate(%),mortality(%)were also compared.The results1.There were significant differences in T lymphocyte subsets between the two groups at different time points in patients with severe multiple trauma.The counts of CD3~+and CD4~+lymphocytes and the ratio of CD4~+/CD8~+were significantly higher in the ulinastatin group than the control group on days 1,3 and 7 after treatment(P<0.05);2.The serum levels of inflammatory factor(TNF-??IL-6)and cortisol of the observation group were significantly lower than those of the control group(P<0.05);3.ALT?BUN?Scr did not show significant differences among the two groups at different time points.The content of cortisol in the body was significantly different before and after treatment in the Ulinastatin treatment group on the 3rd day,7th day(P<0.05);4.The days in ICU,the average days of stay hospital and the incidence of complications of Ulinastatin treatment group were shorter than that of the contrast group(P<0.05).But the 28-day fatality rate didn?t have significant difference in the two groups.Conclusions:Ulinastatin can promote the recovery of T lymphocyte subsets,decrease the release of inflammatory cytokines and reduce the inflammatory response in early after severve multiple injuries,and can decrease the days in ICU,the average day of stay hospital and the incidence of complications,but it can not change the 28-day fatality rate.However,the therapeutic mechanism of ulinastatin is still to be verified by multi-center,large-scale clinical studies.The optimal dose and timing of ulinastatin administration need further clinical research.