不同剂量乌司他丁对心肺复苏后患者的疗效及作用机制

目的:研究不同剂量乌司他丁对心肺复苏后患者的疗效及其作用机制。方法:将58例心肺复苏自主循环恢复(return of spontaneous circulation,ROSC)后存活>72 h的患者,随机分为Ⅰ组(n=21),Ⅱ组(n=19)及对照组(n=18)。Ⅰ组予乌司他丁40万U.d-1,Ⅱ组予乌司他丁80万U.d-1,对照组(n=18)不用乌司他丁。酶联免疫检测ROSC即刻及ROSC后72 h外周血肿瘤坏死因子-α(TNF-α),白细胞介素-4(IL-4),IL-6,IL-10的水平,记录多器官功能障碍综合征(MODS)发生率及28 d生存率,比较3组患者各指标间的差异。结果:治疗前3组患者血清各细胞因子水平差异无统计意义。治疗后Ⅰ,Ⅱ组患者外周血TNF-α,IL-6水平及MODS发生率明显低于对照组(P<0.05或0.01),IL-4,IL-10水平及28 d生存率明显高于对照组(P<0.05或0.01);Ⅱ组患者外周血TNF-α,IL-6水平及MODS发生率明显低于Ⅰ组(P<0.05或0.01),IL-4,IL-10水平及28 d生存率明显高于Ⅰ组(P<0.05或0.01)。结论:乌司他丁能有效抑制心肺复苏后炎症反应,减少MODS发生率,提高复苏存活率。乌司他丁80万U.d-1组复苏治疗效果优于乌司他丁40万U.d-1组。

Clinical efficacy and mechanism of different doses of ulinastatin in patients after successful cardiopulmonary resuscitation

Objective:To study the clinical efficacy of different doses of ulinastatin in patients after successful cardiopulmonary resuscitation and its mechanism of action.Methods:Fifty-eight patients surviving more than 72 hours after successful cardiopulmonary resuscitation were divided into group Ⅰ(n=21),group Ⅱ(n=19)and control group(n=18) randomly.Patients in group Ⅰ received ulinastatin 400 000 U·d-1,patients in group Ⅱreceived ulinastatin 800 000 U·d-1 and patients in control group did not receive ulinastatin.The levels of serum tumor necrosis factor-α(TNF-α),interleukin-4(IL-4),interleukin-6(IL-6),and interleukin-10(IL-10) were measured by enzyme-linked immunosorbentassay(ELISA).In the meantime,the incidence of multiple organs dysfunction syndrome(MODS)and the 28-day survival rate were recorded.Results:Serum cytokine levels in the 3 groups were similar before treatment.After the treatment,the levels of serum TNF-α,IL-6 and the incidence of MODS in groupⅠandⅡ were significantly lower than those in the control group(P<0.05 or 0.01).The levels of serum IL-4,IL-10 and the 28-day survival rate in groupⅠandⅡ were significantly higher than those in the control group(P<0.05 or 0.01).The levels of serum TNF-α,IL-6 and the incidence of MODS in groupⅡ were significantly lower than those in groupⅠ(P<0.05 or 0.01).The levels of serum IL-4,IL-10 and the 28-day survival rate in groupⅡ were significantly higher than those in groupⅠ(P<0.05 or 0.01).Conclusions:Ulinastatin plays a role in inhibiting inflammatory response after CPR.Ulinastatin can reduce the incidence of MODS and increase survival rate in patients after CPR.Ulinastatin 800 000 U·d-1 is superior to ulinastatin 400 000 U·d-1 in the treatment of CPR.