乌司他丁联合山莨菪碱对多发伤致急性肺损伤的预防性治疗研究

目的探讨联合应用乌司他丁和山莨菪碱对多发伤致急性肺损伤(ALI)的预防作用及临床意义。方法将2005年1月至2008年1月诊治多发伤病例586例,严格按照损伤控制学理论治疗多发伤的原则分为四组:常规治疗组142例、乌司他丁治疗组143例、山莨菪碱治疗组152例及联合用药治疗组149例,四组又按照损伤严重评分(ISS)分成三组:ISS<20分组,20分≤ISS<27分组和ISS≥27分组。联合用药组为静脉应用乌司他丁和山莨菪碱。观察四组患者的ICU治疗天数、ALI及急性呼吸窘迫综合征(ARDS)患病率及多发伤患者的病死率。结果联合用药组、单独用药组和常规治疗组相互比较,ISS<20分的多发伤患者四组ICU观察天数均值、ALI/ARDS患病率与多发伤患者的病死率比较差异无统计学意义(P>0.05);ISS≥20分组中,单独用乌司他丁和(或)山莨菪碱治疗的ICU观察天数少于常规治疗组,而ALI/ARDS患病率及病死率也明显降低(P<0.05);ISS≥20分的联合用药组与单独用药组比较,ICU观察天数均值、ALI/ARDS患病率及病死率均明显降低(P<0.05)。结论预防性应用乌司他丁和(或)山莨菪碱治疗多发伤,可以减少严重创伤(ISS≥20分)ICU治疗天数,降低ALI/ARDS的患病率和多发伤患者的病死率;联合用药具有协同效应。

Study on preventive effect of ulinastatin and anisodamine against acute lung injury caused by severe multiple injury

Objective To assess the clinical preventive effect outcome of severe multiple injury patients with acute lung injury（ALI）treated with ulinastatin and anisodamine.Methods A total of 586 multiple injury patients from January 2005 to January 2008 were included in this study and their data were collected and analyzed retrospectively.All the patients were divided into four groups：the conventional treatment group with 142 cases,ulinastatin group of 143 patients,anisodamine group with 152 patients,and combined ulinastatin and anisodamine treatment group followed by injecting ulinastatin and anisodamine 149 cases.All groups were divided into 3 subgroups according to injury severity score（ISS）,less than 20 points（group Ⅰ）,20 to 27（group Ⅱ）,more than 27（group Ⅲ）.ICU hospitalization days,morbidity incidence and mortality of ALI/ARDS between preventive treatment group and conventional treatment group were analyzed.Results There were no significant differences in the four groups when ISS is less than 20 upon ICU hospitalization days,morbidity incidence and mortality of ALI/ARDS.But when ISS is over 20,patients in ulinastatin group,anisodamine group compared with those in conventional treatment group had significantly better ICU hospitalization days,morbidity incidence and mortality of ALI/ARDS（P0.05）,especially and when treatment of combined ulinastatin and anisodamine.Conclusions Ulinastatin and anisodamine decrease ICU hospitalization days and improve morbidity incidence and mortality of ALI/ARDS in multiple injury patients whose ISS more than 20.ICU hospitalization days,morbidity incidence and mortality of ALI/ARDS are not significantly different in patients whose ISS less than 20.