蛋白酶抑制剂对外科高危病人SIRS与MODS作用的研究  

Urinary trypsin inhibitor in SIRS and MODS of critically ill surgical patients:a placebo-controlled study

作　　者：吴健锋[1] 管向东[1] 徐向东[1] 黄顺伟[1] 刘秀琴[2] 

机构地区：[1]中山大学附属第一医院外科重症监护中心,广东广州510080 [2]中山大学附属第一医院检验中心,广东广州510080

出　　处：《中国实用外科杂志》2006年第12期936-938,共3页Chinese Journal of Practical Surgery

基　　金：获广州市科委基金资助(课题号:2003Z3-E0301)

摘　　要：目的评价蛋白酶抑制剂乌司他丁(UTI)对外科高危病人的疗效,通过观察细胞因子的变化和临床转归的影响来探讨其作用机制。方法选择符合入选标准共58例,随机分为乌司他丁治疗组(U组,n=30)和对照组(C组,n=28)。U组病人在接受标准常规治疗的同时接受蛋白酶抑制剂(UTI)治疗,术后12h内开始静脉注射UTI,每次20万单位,每天两次,连续5d。C组病人接受常规治疗+安慰剂(生理盐水)。在治疗前后24、48、72h测定TNF-α、IL-6、IL-8,一氧化氮(NO)、血乳酸、肌酐(Cr),并进行治疗前、后APACHEII评分,观察住院时间和病死率。结果U组病人IL-6、IL-8、TNF-α、APACHEⅡ评分的平均值较C组显著降低。Cr、NO、血乳酸的浓度在治疗后两组间差异无显著性意义。两组住院时间和病死率差异无显著性意义。结论UTI可抑制外科高危病人促炎因子IL-6、IL-8、TNF-α,降低病人APACHEⅡ评分,但对临床转归有无影响,有待于进一步观察研究。Objective To evaluate the efficacy of urine trypsin protease inhibitor in critically ill surgical patients and explore the mechanisms. Methods Fifty-eight patients according with the criteria were randomly divided into ulinastatin treatment group （group U, n = 30） and control group （group C, n = 28）. Patients in the group U received ulinastatin 200 000 units intravenous twice a day in 12 hours after operation,while those in the group C received equal quantity of normal saline as placebo. At the time of admission and 24,48,72 hours after initiation of treatment, serum levels of Cr, Lactic Acid, NO, IL-6, IL-8 ,TNF-α were measured and APACHE Ⅱ scores were made. The time of stay in SICU and mortality rate were recorded. Results Plasma concentrations of three cytokines, IL-6, IL-8,TNF-α and APACHE scores in group U decreased more obviously than those in group C. Plasma concentrations of Cr, Lactic Acid, NO showed no significant difference between the two groups. Length of stay in the SICU and mortality rate showed no significant difference between two groups. Conclusion Urine trypsin protease inhibitor can decrease the blood concentration of inflammatory cytokines TNF-α, IL-6 and IL-8 in critically ill surgical patients. It can reduce APACHE Ⅱ scores. But it can not show a beneficial effect on clinical outcome in critically ill patients. Further study is need to test whether it can reduce the mortality rate of MODS.

关 键 词：乌司他丁 细胞因子 APACHEⅡ评分 

分 类 号：R6[医药卫生—外科学]