乌司他丁治疗急性肺损伤/急性呼吸窘迫综合征34例临床分析

目的:观察乌司他丁(ulinastatin,UTI)对急性肺损伤/急性呼吸窘迫综合征(acute lung injury/acute respiratory distress,ALI/ARDS)的治疗作用。方法:选择34例ALI/ARDS患者,随机分为UTI治疗组(n=17)和对照组(n=17);对照组接受常规治疗,UTI治疗组在常规治疗基础上静脉推注乌司他丁20万u,每8h 1次,连用10天。观察两组的临床疗效并监测患者的心率、呼吸、平均动脉压、动脉血气以及治疗前及治疗第4天、第7天的血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、IL-6水平变化。结果:UTI治疗组与对照组在治疗前TNF-α、IL-1、IL-6水平差异均无统计学意义(P>0.05)。治疗后UTI治疗组的TNF-α、IL-1、IL-6水平下降较对照组明显(P<0.01),UTI治疗组中呼吸频率减慢、心率减慢,动脉血氧饱和度改善,平均动脉压下降,血气分析证实动脉血氧分压、动脉血氧分压/吸入氧气浓度明显上升,明显优于对照组(P<0.01)。结论:乌司他丁可显著抑制机体炎症介质的产生,从而减轻炎性反应对机体的损伤,改善ALI/ARDS的预后。

Ulinastatin for treatment of acute lung injury/acute respiratory distress syndrome:an analysis of 34 cases

Objective：To observe the therapeutic effect of ulinastatin on acute lung injury/acute respiratory distress syndrome（ALI/ARDS）.Methods：Thirty-four patients with ALI/ARDS were randomly divided into treatment group（n=17）and control group（n=17）.The control group received only the routine therapy,and the treatment group were given ulinastatin（200 ku intravenously,once every 8 hours,and continued for 10 days）in addition to the routine treatment.The efficacy was assessed in both groups.The parameters of heart rate,respiratory rate,oxygenation,average arterial blood pressure and arterial blood gas were monitored.Serum levels of tumor necrosis factor-α（TNF-α）,interleukin-1（IL-1）and IL-6 were measured on admission,the day 4 and the day 7 in both groups.Results：Before treatment,the TNF-α,IL-1 and IL-6 levels were not significantly different between the ulinastatin group and the control group（P〉0.05）;but descended significantly after treatment in the ulinastatin group（P〈0.01）,as well as therespiratory rate,heart rate,and the average arterial blood pressure.The blood gas analysis proved that PaO2 and PaO2/FiO2 increased significantly in the treatment group compared with those in the comparison group（P〈0.01）.Conclusions：Ulinastatin may significantly inhibit the production of inflammatory cytokinases and thus prevent the systemic injury by inflammatory response and improve the prognosis of ALI/ARDS.