急性呼吸衰竭纤维支气管镜肺段冲洗乌司他丁干预的临床研究

目的 评价纤维支气管镜肺段冲洗联合机械通气乌司他丁干预对控制胸腹部手术后急性呼吸衰竭、防治多脏器功能障碍综合征（MODS）及降低其病死率的作用.方法 56例胸腹部手术后急性呼吸衰竭患者随机分为纤维支气管镜肺段冲洗联合机械通气组（n=30）和纤维支气管镜肺段冲洗联合机械通气乌司他丁干预组（n=26）,比较两组患者呼吸力学、动脉血气及血流动力学的变化.观察两组患者肺及肺外脏器功能改善率、ICU病死率及其死亡原因等.结果 两组患者年龄和APACHE Ⅱ评分比较差异无显著性（P＞0.05）;纤维支气管镜肺段冲洗联合机械通气乌司他丁干预组对患者呼吸力学、动脉血气及血流动力学的影响均优于单纯使用纤维支气管镜肺段冲洗联合机械通气组;乌司他丁治疗组多脏器功能衰竭（MODF）的病死率为15.3%,明显低于对照组（25.6%,P＜0.05）.结论 纤维支气管镜联合机械通气乌司他丁干预能进一步改善胸腹部手术后急性呼吸功能衰竭患者的呼吸力学、动脉血气及血流动力学指标,并在防治MODS及降低急性呼吸衰竭患者病死率上有显著临床效果.

Clinical study on ulinastatin intervention in bronchoscope bronchial lavage to save the patients with acute respiratory failure

Objective] To evaluate the effects of ulinastatin intervention in bronchoscope bronchial lavage joint mechanical ventilation to save the patients with thoracic or abdomen surgical postoperative infection of the lung merge actue respiratory failure, prevention and cure of multiple organ dysfunction syndrome (MODS) and decreasing disease mortality. Methods] 56 acute respiratory failure patients were randomly divided into bronchoscope bronchial lavage joint mechanical ventilation group (n =30) and ulinastatin intervention in bronchoscope bronchial lavage joint mechanical group (n =26). We compared the changes of pneumodynamics, arterial blood gas and hemodynamics of the two group, and observed the function improvement rate of lung and extrapulmonary organs, and complication disease mortality in ICU and causes of death. Results] There were no significant differences in the age and acute physiology and chronic health evaluation II (APACHE-II) scores of the two groups (P >0.05). Ulinastatin intervention in bronchoscope bronchial lavage joint mechanical ventilation had further improved influence on pneumodynamics, arterial blood gas and hemodynamics than bronchoscope bronchial lavage joint mechanical ventilation. The disease mortality in ICU for multiple organ failure of ulinastatin intervention group was 15.3%,with was obviously superior to the rate (25.6%) of bronchoscope bronchial lavage joint mechanical ventilation group (P <0.05). Conclusions] Ulinastatin intervention in bronchoscope bronchial lavage joint mechanical ventilation can improve the pneumodynamics, arterial blood gas and hemodynamics of the patients with thoracic or abdomen surgical postoperative infection of the lung merge acute respiratory failure. It has great clinical effects on the prevention and cure of MODS and decreasing the disease mortality of acute respiratory failure.