目的 觀察谷氨酰胺聯(lián)合烏司他丁治療膿毒癥患者的臨床療效及機(jī)制。方法 選取2014年3月-2017年6月中山市博愛(ài)醫(yī)院重癥監(jiān)護(hù)室收治的膿毒癥患者78例，按隨機(jī)數(shù)字表法分為對(duì)照組和觀察組，每組39例。對(duì)照組給予烏司他丁40萬(wàn)U/次，3次/d；觀察組在對(duì)照組的基礎(chǔ)上給予谷氨酰胺0.4 g/（kg·d），均治療1周。比較兩組治療前后APACHE Ⅱ評(píng)分、血清腫瘤壞死因子-α（TNF-α）、白介素（IL）-6、IL-1β及免疫球蛋白G（IgG）、免疫球蛋白A（IgA）、免疫球蛋白M（IgM）濃度的變化，比較兩組不良反應(yīng)的發(fā)生情況。結(jié)果 治療前，兩組患者APACHE Ⅱ評(píng)分、血清TNF-α、IL-6、IL-1β及IgG、IgA、IgM濃度間無(wú)顯著性差異。治療后，觀察組APACHE Ⅱ評(píng)分為（14.2±3.7）分，顯著低于對(duì)照組的（16.3±4.4）分，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者血清TNF-α、IL-6、IL-1β濃度均顯著降低，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且觀察組以上指標(biāo)明顯低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者血清IgG、IgA、IgM濃度均顯著升高，同組治療前后比較差異有統(tǒng)計(jì)學(xué)意義（P<0.05），且觀察組以上指標(biāo)顯著高于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療期間，觀察組不良反應(yīng)發(fā)生率（2.56%）與對(duì)照組（5.13%）無(wú)差異。結(jié)論 谷氨酰胺聯(lián)合烏司他丁治療膿毒癥療效好，能抑制炎癥反應(yīng)并促進(jìn)患者免疫功能的恢復(fù)，值得臨床應(yīng)用于推廣。

Objective To explore the clinical efficacy and mechanism of glutamine combined with ulinastatin in the treatment of ICU sepsis. Methods Selected 78 patients who with sepsis in our hospital intensive care unit from March 2014 to June 2017. All patients were divided into control group and observation group by random number table method, each group of 39 cases. The control group was treated with ulinastatin, the observation group was treated with glutamine based on the control group. APACHE Ⅱ scores, serum TNF-α, IL-6, IL-1β and IgG, IgA and IgM levels were compared between the two groups before and after treatment. The incidence of adverse reactions was compared between the two groups. Results There was no significant difference in APACHE Ⅱ score, serum TNF-α, IL-6, IL-1β and IgG, IgA and IgM levels between the two groups before treatment. The APACHE Ⅱ score (14.2±3.7) in the observation group was significantly lower than that in the control group (16.3±4.4) (P<0.05) after treatment. The levels of serum TNF-α, IL-6 and IL-1β were significantly decreased in both groups after treatment, and observation groups was significantly lower than that in the control group (P<0.05). The levels of serum IgG, IgA and IgM were significantly increased in both groups after treatment, and observation groups was significantly higher than that in the control group (P<0.05). The incidence of adverse reactions in the observation group (28.21%) was significantly lower than that in the control group (61.54%) (P<0.05). Conclusions Glutamine combined with ulinastatin in the treatment of sepsis is effective, can inhibit the inflammatory response and promote the recovery of immune function in patients, worthy of clinical application in the promotion.