乌司他丁在慢阻肺疾病急性发作中的应用及对炎性因子的影响研究

目的观察并探讨乌司他丁注射液在慢阻肺疾病急性发作(AECOPD)中的临床疗效及对外周血炎性因子的影响。方法将2013年1月~2014年12月入选的113例AECOPD患者随机分为观察组(58例)和对照组(55例),对照组给予常规氧疗、抗感染、解痉及基础疾病的对症治疗,观察组在对照组基础上联合静脉泵注乌司他丁注射液,每次20万IU,每日2次,连续7 d,治疗7 d后,对比两组动脉血气指标、肺功能指标、外周血炎性因子指标并判定临床疗效。结果治疗7d后,观察组FEV_1%(75.8±6.2)%、FEV_1/FVC%(73.5±6.7)%数值显著高于对照组(73.1±5.7)%、(70.9±6.1)%(P0.05);观察组治疗后PaO_2(80.5±7.1)mm Hg显著高度对照组(77.2±6.5)mm Hg,而PaCO_2(42.4±4.0)mm Hg显著低于对照组(44.1±3.7)mm Hg,差异均有统计学意义(P0.05);观察组治疗后IL-6(37.1±12.5)pg/ml、IL-8(30.7±11.3)pg/ml、TNF-α(82.4±23.0)pg/ml、hs-CRP(27.9±10.1)mg/L均显著低于对照组水平(46.6±14.2)pg/ml、(38.7±13.1)pg/ml、(96.2±20.4)pg/ml、(40.2±15.1)mg/L(P0.05)。治疗7 d内,观察组实施有创通气比例(5/58,8.6%)明显低于对照组(12/55,21.8%)(fisher P=0.044)。观察组总有效率(94.8%)高于对照组(90.1%),但差异无统计学意义(P0.05)。结论 AECOPD患者在抗感染、氧疗基础上联合使用UTI注射液,能显著减轻炎性反应对肺组织的损伤,明显改善肺通气与换气功能,有助于进一步提高临床疗效。

Application and efficacy of ulinastatin in the treatment of patients with AECOPD and its effect on inflamma-tory factors

Objective To observe and explore clinical efficacy of UTI in the treatment of AECOPD and its effect on peripheral blood inflammatory factors. Methods 113 AECOPD patients were selected as study objects and were randomly divided into the observation group (58 cases) and the control group (55 cases). The control group was given conventional oxygen therapy, anti infection, spasmolysis and symptomatic treatment of underlying diseases, and the observation group was added with intravenous infusion of UTI injection, 200,000 IU per time, twice a day for 7 consecutive days. 7 days after the treatment, their arterial blood gas, lung function, peripheral blood inflammatory factors and clinical efficacy were compared between the two groups. Results 7 days after the treatment, the value of FEV1% and FEV1/FVC% were (75. 8 ± 6. 2)% and (73. 5 ± 6. 7)% in the observation group, which were signifi-cantly higher than those in the control group [(73. 1 ± 5. 7)%, (70. 9 ± 6. 1%)] (P<0. 05). The level of PaO2 was 80. 5 ± 7. 1 mmHg, which was significantly higher than that in the control group (77. 2 ± 6. 5) mmHg, and the level of PaCO2 was significantly lower in the observation group (42. 4 ± 4. 0) mmHg than in the control group (44. 1 ± 3. 7) mmHg (P<0. 05). The levels of IL-6, IL-8, TNF-α and hs-CRP were (37. 1 ± 12. 5) pg/ml, (30. 7 ± 11. 3) pg/ml, (82. 4 ± 2. 3) pg/ml, and (27. 9 ± 10. 1) mg/L respectively in the observation group, which were significantly lower than those in the control group respectively [ ( 46. 6 ± 14. 2 ) pg/ml, ( 38. 7 ± 13. 1 ) pg/ml, (96. 2 ± 20. 4) pg/ml and (40. 2 ± 15H1) mg/L (P<0. 05)]. The ratio of invasive ventilation was 8. 6% (5/58) in the observation group and 21. 8% (12/55) in the control group (P=0. 044). The total effective rate was 94. 8%in the observation group and 90. 1% in the control group (P>0. 05). Conclusion Based on conventional anti in-fection, oxygen therapy for patients with AECOPD, UTI injection can significantly relieve lung tissue damage induced by inflammatory reaction, improve pulmonary ventilation and gas exchange function obviously, and help to improve the clinical efficacy.