乌司他丁对左向右分流型先天性心脏病患儿术后肺部感染的治疗作用

目的观察乌司他丁对左向右分流型先天性心脏病术后患儿肺部感染的治疗作用。方法对作者医院2010—10／2012—12月收治的60例14岁以下左向右分流型先天性心脏病术后发生肺部感染的患儿，随机分为乌司他丁组和对照组，每组30例。治疗上给予雾化吸入异丙托溴铵和氨溴索，定时叩背排痰等，根据痰培养结果选用敏感抗生素。乌司他丁组给予乌司他丁5000U／kg，2次／d，持续5天；对照组不使用乌司他丁。观察两组患儿治疗效果；比较治疗1周内两组患儿动脉血氧分压（partial pressure of oxygen，PaO2）和氧合指数（oxygenation index，OI）动态变化情况；治疗后两组患儿（PaO2）、动脉二氧化碳分压（partial pressure of carbon dioxide，PaCO2）、乳酸（lactic acid，LAC）和OI等；治疗后两组患儿外周血白细胞计数（white blood cell count，WBC）、降钙素原（procalcitonin，PCT）和C反应蛋白（C-reactive protein，CRP）及肺部感染持续时间和抗生素使用时间。结果治疗过程中两组各有2例患儿行气管插管呼吸机辅助呼吸，治疗后所有患儿均痊愈出院。乌司他丁组患儿在治疗3天后PaO2和OI曲线高于对照组，并持续至观察结束。与对照组比较，乌司他丁组患儿治疗后，PaCO2和OI高，LAC、WBC、PCT和CRP较低，肺部感染和抗生素使用时间较短。除PaCO2外，上述检测指标组间比较均有统计学意义（P〈0．05或0．01）。结论乌司他丁对左向右分流型先天性心脏病术后患儿肺部感染的治疗作用明确，能够稳定病情，缩短肺部感染时间。

Treatment Effects of Ulinastatin in Children with Left-to-right Shunt Congenital Heart Disease Complicated with Pulmonary Infection Post-operation

Objective To investigate the treatment effects of ulinastatin in children with left-to-right shunt congenital heart disease complicated with pulmonary infection post-operation. Methods A total of 60 children with left-to-right shunt congenital heart disease complicated with pulmonary infection post-operation from October 2010 to December 2012 were randomly divided into ulinastatin group （UTI group,30 cases ） and control group （CTL group,30 cases）. Inhalation of Ambroxol Hydrochloride and Ipratropium Bromide, back percussion and sputum suction and sensitive antibiotics selected by sputum cultivation were used for treatment. UTI group received 5000 U/kg of ulinastatin twice per day for 5 days. CTL group received no ulinastatin. The clinical records from two groups were compared in terms of treatment effect, variation tendency of partial pressure of oxygen （PaO2） and the oxygenation index in one week treatment. PaO2, partial pres sure of oxygen （PaCO2）, the oxygenation index, lactic acid （LAC）, white blood cell count （WBC）, procalcitonin （PCT） and C-reactive protein （CRP） after treatment, pulmonary infection lasting time and antibiotic usage time. Results Re-intubation occurred in two cases respectively in both groups. All patients were successfully cured and discharged from hospital. PaO2 curve and the oxygenation index were higher in UTI group than those in CTL group from three days after treatment to the end of observation. Compared with CTL group, UTI group had higher PaO2 and oxygenation index, lower LAC, WBC, PCT and CRP, shorter pulmonary infection lasting time and antibiotic usage time （〈0. 05）. There was no statistical difference between two groups in PaCO2. Conclusion Ulinastatin has good treatment effects in children with left-to-right shunt congenital heart disease complicated with pulmonary infection post-operation, can stabilize patho-genetic condition and shorten pulmonary infection lasting time.