摘要目的:分析脉搏指示持续心输出量（PiCCO）监测下左西孟旦与乌司他丁联用治疗脓毒性休克患者的临床疗效及其对肝素结合蛋白（HBP）和内皮细胞特异性分子（endocan）的影响。方法:选择2017年3月至2019年5月在山西医科大学第一医院接受治疗的脓毒性休克患者157例作为研究对象，根据随机数字表分为对照组（ n=79）和观察组（ n=78）。对照组予以PiCCO监测下静脉滴注左西孟旦，观察组在对照组治疗基础上，联合静脉滴注乌司他丁。比较两组临床疗效、血生化指标及血清HBP、endocan含量等指标。 结果:观察组有效率为95%，高于对照组的77%，两组比较，差异有统计学意义（ P<0.05）。治疗后，观察组患者血清C反应蛋白（CRP）、降钙素原（PCT）、WBC、脑钠肽（BNP）、肌钙蛋白I（TnI）、肌钙蛋白T（TnT）、肌酸同工酶（CK-MB）、HBP、endocan水平和APACHE Ⅱ评分均低于对照组（均 P<0.05）。 结论:PiCCO监测下左西孟旦与乌司他丁联用可有效治疗脓毒性休克，并可改善患者血生化指标，降低血清HBP、endocan水平，具有较高的临床应用价值。

abstractsObjective:To investigate the clinical efficacy of Levosimendan combined with Ulinastatin in the treatment of septic shock and its effect on heparin-binding protein (HBP) and endocan under continuous pulse indicator cardiac output (PiCCO) monitoring.Methods:A total of 157 patients with septic shock treated in First Hospital of Shanxi Medical University between March 2017 and May 2019 were enrolled. According to random number table, they were divided into a control group ( n=79) and a study group ( n=78) . The control group received intravenous drip of levosimendan under PiCCO monitoring; in addition to this, the study group received intravenous drip of ulinastatin as part of combination therapy. The clinical efficacy, blood biochemistry, serum HBP and endocan levels were compared between the two groups. Results:The treatment response was 95% in the study group, which was higher than that (77%) in the control group, with statistical difference between the two groups ( P<0.05) . After treatment, the study group showed significantly lower levels or values of serum C-reactive protein (CRP) , procalcitonin (PCT) , WBC, brain natriuretic peptide (BNP) , troponin I (TnI) , troponin T (TnT) , creatine, CK-MB, HBP, endocan and APACHE Ⅱ score, compared with the control group (all P<0.05) . Conclusion:Combined use of levocimendan and ulinastatin under PiCCO monitoring can effectively correct septic shock, improve blood biochemistry, reduce serum HBP and endocan levels, and therefore is highly valuable in clinical setting.