乌司他丁对ARDS肺血管内皮通透性的临床研究

目的观察乌司他丁对急性呼吸窘迫综合征（ARDS）患者肺血管内皮通透性的变化：方法将54例ARDS患者随机分为治疗组与对照组。两组给予常规综合及机械通气治疗，治疗组在综合治疗的基础上静脉给予乌司他丁：观察两组治疗前后血管外肺水指R（EVLWI）、肺血管通透性指数（PVPI）、急性生理和慢性健康状态评分（APACHE）Ⅱ、全身性感染相关性器官功能衰竭评分（SOFA）等的变化，评价机械通气时间、ICU住院时间与病死率的差异。结果治疗组EVLWI、PaO2/FiO2、APACHEⅡ评分在治疗后3d、7d与对照组比较，差异均有统计学意义（t分别=2．27、2．86、3．91、5．34、2．52、3．23，P均〈0．05）；PVPI、SOFA评分在治疗后7d与对照组比较，差异有统计学意义（t分别=5．02、2．25，P均〈0．05）。治疗后治疗组的机械通气时间、ICU住院时间明显缩短，与对照组比较，差异均有统计学意义（t分别=3．39、3．58，P均〈0．05）；两组患者28d死亡率比较，差异无统计学意义（x^2=0．38，P〉0．05）。结论乌司他丁能增加氧合，改善ARDS患者肺血管通透性，减少机械通气时间及ICU住院时间．

Effects of ulinastrtin on pulmonary endothelial permeability in patients with ARDS

Objective To evaluate the effect of ulinastatin on pulmonary endothelial permeability via pulseindicated continuous cardiac output （PiCCO） in patients with acute respiration distress syndrome （ARDS）. Methods Fifty-four patients with ARDS were divided into mechanical ventilation group （control group） and mechanical ventilation combined ulinastatin group （ulinastatin group）. The extra-vascular lung water index （EVLWI）, pulmonary vascular permeability index（PVPI）, acute physiology and chronic health evaluation （APACHE Ⅱ ） and sepsis-related organ failure assessment （SOFA） score were recorded.The duration of ventilation, length of stay in ICU and case fatalities of two groups also assessed. Results The EVLWI, PaO2/FiO2 and APACHE Ⅱ score at the 3rd , 7th day in ulinastatin group were significantly lower than the control group （t=2.27,2.86,3.91,5.34,2.52, 3.23,P〈0.05）; the same result was observed in PVPI and SOFA scores at the 7th day （t=5.02,2.25 ,P〈0.05）. After therapy, the duration of ventilation and length of stay in ICU in ulinastatin group was significantly shorter than the control group （t= 3.39,3.58,P〈0.05）.The mortality of 28 days of two groups were not distinct （x^2=0.38,P〉0.05）. Conclusions Ulinastatin treatment improved hypoxemia, elevated pulmonary endothelial permeability, reduced duration of ventilation and length of stay in ICU in patients with ARDS.