乌司他丁在保护心肺复苏患者重要脏器中的意义：131例临床分析

目的研究乌司他丁在保护接受心肺复苏患者的重要脏器中的作用。方法131例CPR患者随机分为3组：A组（n=41），在开始心肺复苏同时开始应用乌司他丁（20万单位溶于20ml生理盐水中静脉注射，1次／12h，共8次）；B组（n=46），心搏恢复后立即开始应用乌司他丁（20万单位溶于20ml生理盐水中静脉注射，1次／12h，共9次）；C组（n=44），在心肺复苏时和以后均不用乌司他丁。观察各组的存活率，住院时间，全身炎症综合征（SIRS）发生率。存活≥24h的患者于24h抽取外周血测定白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF—α）、肌酸激酶（CK），天门冬氨酸转氨酶（AST），丙氨酸转氨酶（ALT）和肌酐（Cr）。30例正常人作为对照组，检查血液内的上述因子水平。结果3组患者外周血IL-6、TNF—α的水平均高于对照组（均P〈0．05）。A组患者IL-6、TNF-α的水平，以及CK、AST、AIJrr、和Cr值均明显低于B，C组（均P〈0．05），B组的上述指标亦显著低于C组（均P〈0．05）。A组的SIRS发生率为33％，显著低于B和C组（47％和68％，均P〈0．05），A组的住院时间为（10．60±6．67）d，显著短于B和C组f（15．62±9．47）d和（2t．33±9．77）d，均P〈0．05），A组患者的24h后死亡率为12％，显著低于B和C组（28％和47％，均P〈0．05）；B组的上述指标亦均显著低于C组（均P〈0．05）。24h内死亡率在3组之间无显著性差异（均P〉0．05）。结论乌司他丁能有效地抑制CPR时机体炎症反应并保护患者重要脏器的功能，提高心肺复苏的成功率，尤其是在心肺复苏时同时应用乌司他丁时。

Protective effects of ulinastain on patients undergoing cardiopulmonary resuscitation: clinical analysis of 131 cases

Objective To investigate the protective effects of ulinastain （UTI） on patients undergoing cardiopulmonary resuscitation （CPR） Methods One hundred and thirty-one patients with cardiac arrest who underwent CPR were randomly divided into 3 groups： Group A （n=41） undergoing administration of UTI 200,000 units in 20 ml normal saline injected intravenously during CPR once per 12 h for 8 times; Group B （n=46） given the same amount of UTI after the restoration of heart beat for 9 times, and Group C （n=44） without UTI treatment. Systemic inflammatory response syndrome （SIRS） rate, survival rate, and hospital stay time, were observed. Peripheral blood samples were collected from the patients surviving over 24 hr to detect the interleukin-6 （IL-6） , tumor necrosis factor-α （TNF- α）, creatine kinase （CK）, aspartate aminotransferase （AST）, alanine transaminase （ALT）, and creatinine （Cr）. Thirty healthy persons undergoing health physical examination were used as controls. Results The levels of IL-6 and TNF- α of Groups A, B, and C were all significantly higher than those of the control group （all P〈0.05）. The IL-6 , TNF- α , CK, AST, ALT, and Cr levels of Group A were all significantly lower than those of Groups B and C （all P〈0.05）, and those of Group B were all significantly lower than those of Group C as well （all P〈0.05）. The SIRS rate of Group A was 33%, significantly lower than those of Groups B and C （47% and 68%, both P〈0.05）; The CK, AST, ALT, and Cr levels of Group A were all significantly lower than those of Groups B and C （all P〈0.05）. There was not significant difference in the mortality during 24 hours among these 3 CPR groups （all P〉 0.05）. The mortality after 24 hours of Group A was 12%, significantly lower than those of Groups B and C （28% and 47% respectively, both P〈0.05） and that of Group B was significantly lower than that of Group C as well （P〈0.05）. The hospital stay time of Group A was （ 10.60 ± 6.67） d, significantly shorter than those of Groups B and C （ 15.62 ± 9.47 ）d and （21.33±9.77 ）d respectively, both P〈0.05], and that of Group B was significantly shorter than that of Group C as well （P〈0.05）. Conclusion UTI effectively protects the important organs of the patients undergoing CPR by inhibiting the inflammatory response, especially when UTI is administered during CPR simultaneously.