乌司他丁治疗重症肺炎的临床观察

目的：观察乌司他丁治疗急性重症肺炎损伤的临床效果。方法：80例确诊的重症肺炎患者被随机分为对照组和治疗组,每组40例。对照组患者给予常规治疗,治疗组患者在常规治疗基础上,加用20U乌司他丁静脉泵注,每日2次,连续治疗7～10d。比较患者治疗前、治疗后3d以及治疗后6d动脉血气指标、呼吸力学指标、炎性细胞因子指标变化,并对疗效及预后进行评价。结果：两组患者氧饱和度（SaO2）、氧分压（PaO2）和氧合指数（PaO2/FiO2）在治疗后3d和6d均较治疗前有明显改善（P〈0.05）,且治疗组PaO2/FiO2较对照组有显著改善（P〈0.05）;治疗组患者6d的气道峰压较对照组明显下降（P〈0.05）;两组患者IL-6、CRP、TNF-α和WBC也均较治疗前有明显改善（P〈0.05）,且治疗组各指标较对照组有显著改善（P〈0.05）;治疗组较对照组能明显缩短机械通气时间和住院时间（P〈0.05）,但两组的疗效和28d生存率比较,差异无统计学意义（P〉0.05）。结论：在运用常规治疗的基础上,加用乌司他丁治疗重症肺炎,能有效改善重症肺炎患者的临床体征,减轻肺组织损伤,达到更佳的治疗效果。

Clinical observation of ulinastatin in the treatment of patients with severe pneumonia

Objective：To observe the therapeutic effect of ulinastatin on patients with severe pneumonia.Method：Eighty patients with severe pneumonia were randomly divided into two groups：ulinastatin treatment group（n =40） and control group（n=40）.Routine treatment was given in both groups.Patients of ulinastatin treatment group were given an additional ulinastatin（200 000U,micro pump per 12h,7～10d） treatment.Mean changes of arterial blood gas,respiratory mechanics and inflammatory cytokine from baseline to 3and 6days after treatment were compared between-and within-groups.Result：We found a significant beneficial effect on SaO 2,PaO 2 and PaO 2 /FiO 2 in both groups after 3and 6days treatment（P0.05）.There was a significant improvement of PaO 2 /FiO 2 in the ulinastatin treatment group compared with the control group（P0.05）.Compared with the controls,airway pressure showed significant decreases in the ulinastatin treatment group after 6days treatment（P0.05）.Our results also suggested a significant beneficial effect on IL-6,CRP,TNF-αand WBC in both groups after treatment（P0.05）.There was a significant improvement in the ulinastatin treatment group compared with the control group（P0.05）.In addition,the average duration of mechanical ventilation and hospitalization time of ulinastatin treatment group were significantly shorter than that of the control group（P0.05）.But there were no significant differences between the two groups in treatment effects and 28-day mortality（P0.05）.Conclusion：Conventional treatment plus ulinastatin showed significant effects on patients with severe pneumonia.It can reduce lung injury and improve the clinical signs of patients with severe pneumonia.