严重烧伤血清细胞因子的变化及乌司他丁治疗作用分析

目的:探讨严重烧伤早期某些血清细胞因子的变化及乌司他丁(UTI)的治疗作用.方法:将收治的伤后24小时内入院、烧伤面积≥50%TBSA的严重烧伤患者42例,于入院当日检测血清细胞因子水平及肝、肾功能指标,随机分为UTI(乌司他丁)治疗组(21例)和常规治疗组(21例);UTI治疗组在常规治疗的基础上给予UTI 30万IU,加入生理盐水10 ml中静脉推注, 1次/8小时,连续14 天;烧伤后7天重复检测两组血清细胞因子及肝、肾功能指标;伤后28天统计全身炎症反应综合征(SIRS)并发症发生率和存活率.结果:①血清细胞因子水平:烧伤当日,治疗组与对照组病人血清细胞因子水平均呈现明显升高,治疗组经UTI治疗7天,血清细胞因子水平均出现下降,明显低于治疗前水平,对照组也出现下降趋势,但下降幅度远不如治疗组,自身前后对照及与对照组之间比较具有显著性差异(P ＜ 0.05);②肝、肾功能指标:烧伤当日,治疗组与对照组病人肝肾功能指标均在正常范围之内,烧伤后7天,除TB升高具有统计学意义外,其他指标治疗前后变化均无临床意义;③并发症:伤后7天治疗组SIRS发生率为42.9%(9/21),对照组为76.2%(16/21);伤后28天,治疗组生存率为95.2%(20/21) ,高于对照组的90.0%(18/21).结论:早期应用UTI治疗严重烧伤,可以降低血清细胞因子水平,减轻炎症反应程度.

The Change of Serum Cytokines for Severe Burn Injury and Clinical Efficacy Analysis of Ulinastatin Treatment

Objective： To investigate the change of some serum cytokines for severe burn injury in the early stage and clinical efficacy of Ulinastatin treatment. Method： Collected 42 cases of severe burn patients with more than 50% TBSA and admission within 24h after injury were randomized into 2 groups. 21 were UTI group and 21 were general treatment group. The patients in UTI group were treated with 300 thousand IU in 10ml of NS in I. V. every 8h and successive 14 days additionally, compared with treatment in control of general group. The index of serum cytokines, hepatic function and renal function were tested in the day of admission for all 2 groups. The index of serum cytokines, hepatic function and renal function were retested on the 7th day post - injured. And incidence rate of SIRS and survival rate were calculated on the 28th day after injured. Result： （1） the level of serum cytokines ： On the day of burn injury, the level of serum cytokines of the patients appeared obviously higher in both UTI group and general group. On the 7th day post - injury, the level of serum cytokines was extremely lower in UTI group and slightly lower in general group compared with that before the treatment. There were significant differences of the level of the serum cytokines compared with before/after treatment in self - control and groups between control and treating （P 〈 0. 05 ）. （2）The index of hepatic function and renal function： The index of hepatic function and renal function of burn patients were normal on the day of burn injury in both of UTI group and general group. On the 7th day post - injury, there was no statistical significant changes in the hepatic and retal indexes observed except with the raising of TB value. （3）Comphcations ： On the 7th day post - injury, the incidence of SIRS was 42. 9% （9/ 21 ） in UTI group, while it was 76. 5% （ 16/21 ） in general treatment group. On the 28th day post - injury, the survival rate of UTI group was 95.2% （20/21）, higher than the contral group （90. 0%, 18/21 ）. Conclusion： It can reduce serum level of cytokines and the degree of inflammatory response, if the severe burns were treated with UTI in the early stage of burn injury.