乌司他丁对严重烧伤患者伤后早期心肌损害的防治作用

目的观察乌司他丁（UTI）对烧伤“休克心”的防治作用，探讨其可能的机制。方法选择笔者单位收治的伤后24h内入院、烧伤面积〉50％TBsA的34例特重度烧伤患者，分为烧伤组和UTI治疗组，每组17例。两组患者均进行常规治疗，且UTI治疗组患者入院后立即给予UTI10万U静脉滴注，3次／d，连续7d。于两组患者伤后2、4、7d采血，检测其血浆中性粒细胞弹性蛋白酶（PMN elastase）、心肌肌钙蛋白I（cTnI）含量和心肌型肌酸激酶同工酶（CK—MB）活性，以公认的各指标正常值作参考，并对3项指标进行相关性分析。结果（1）伤后2、4、7d，两组患者血浆PMN elastase及cTnI含量均显著高于正常值（P〈0．01）；UTI治疗组与烧伤组比较，两指标偏低。（2）与正常值比较，伤后2、4、7d烧伤组患者CK—MB活性明显升高（P〈0．01），第4天达高峰；UTI治疗组伤后2、4d CK—MB活性明显高于正常值（P〈0．05或0．01），但与烧伤组比较升幅较小，第7天降至正常值水平（P〉0．05）。（3）34例烧伤患者PMN elastase、cTnI含量及CK—MB活性三者间均呈现显著正相关，前两者的相关系数为0．904，后两者的相关系数为0．922，PMN elastase含量与CK-MB活性的相关系数为0．829（均为P〈0．01）。结论UTI能够显著减轻严重烧伤患者心肌损害的程度，有效抑制PMN elastase的过度释放。

Effect of Ulinastatin on the management of early myocardiac injury after severe bums

OBJECTIVE: To investigate the effect of Ulinastatin on the management of early myocardial injury and its mechanisms. METHODS: Thirty-four severe burn patients with TBSA exceeding 50% were admitted into our hospital within 24 hrs after burns, and they were divided into burn group (n=17) and ulinastatin-treated group (n=17, UTI group). All patients received conventional treatment. The patients in UTI group were given 100,000 U ulinastatin intravenously immediately after admission, 3 times a day for a week. The plasma content of troponin I (cTnI) , creatine kinase (CK-MB) and PMN elastase were determined on 2, 4 and 7 postburn days (PBD), and the correlate relationship among these three indices were analyzed. RESULTS: (1) The plasma content of cTnI and PMN elastase at 2, 4, 7 PBDs were significantly higher than that of normal value (P < 0.01), but they were obviously lower in UTI group than that in burn group. (2) Compared with normal value, the plasma content of CK-MB in burn group was increased significantly on 2, 4 and 7 PBDs (P < 0.01), and it reached the peak on 4 PBD. Though it was obviously higher in UTS group on 2 and 4 PBDs compared with the normal value, but it was lower than that in burn group ( P < 0.05 or 0.01) , and it returned to normal value on 7 PBD. (3) There exhibited positive correlation among the PMN elastase content, cTnI content and CK-MB activity of the 34 patients. The correlation index of PMN elastase content and cTnI content was 0. 904, while that between cTnI content and CK-MB activity was 0.922, and that between PMN elastase content and CK-MB activity was 0.829 (P < 0.01). CONCLUSION: Ulinastatin is beneficial in alleviating myocardial injury after severe burns, and it reduces the release of PMN elastase.