大剂量地塞米松联合乌司他丁治疗严重肺挫伤  

Therapeutic Effects of High Dose Dexamethasone Combined with Ulinastatin in Treating Sever Pulmonary Contusion

作　　者：陈喜云[1] 钮海弟[1] 徐善明[1] 钟金龙[1] 

机构地区：[1]复旦大学附属金山医院胸外科,上海200540

出　　处：《中国临床医学》2011年第1期62-63,65,共3页Chinese Journal of Clinical Medicine

摘　　要：目的：研究大剂量地塞米松联合乌司他丁治疗严重肺挫伤的疗效与安全性。方法：选择58例严重肺挫伤患者,随机分为A组（n=29）和B组（n=29）。A组接受常规治疗,包括使用地塞米松20~40mg,2次/d,连续3d。B组在常规治疗的基础上联合乌司他丁20万U加入0.9%氯化钠液100mL静脉滴注,每8h1次,连用7d;2组患者治疗第1、第7天行血气分析,并检测治疗第1、第4、第7天血清肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）的含量。比较治疗期间2组患者急性呼吸窘迫综合征（ARDS）的发生率。结果：治疗前2组血气分析指标及血清TNF-α、IL-6水平无显著差异（P〉0.05）;治疗后B组血气分析指标较同期A组显著改善（P〈0.05）,血清TNF-α、IL-6水平较A组显著下降更明显（P〈0.05）。ARDS发生率B组显著低于A组（P〈0.05）。结论：大剂量地塞米松联合应用乌司他丁能显著抑制炎症介质的释放,有效保护严重肺挫伤患者的肺功能。Objective：To observe the therapeutic effects of high dose dexamethasone combined with Ulinastatin in treating sever pulmonary contusion.Methods：A total of 58 patients with sever pulmonary contusion were randomly divided into Group A（n=29） and Group B（n=29）.Both Groups received routine treatment,including dexamethasone（20-40 mg intravenous drip twice one day and continued 3 days）,while the patients of Group B（n=29） were given Ulinastatin（200 kU intravenous drip once every 8 hours and continued 7 days） in addition.Blood gas analysis were detected on the 1st and 7th day and serum tumor necrnsis factor alpha（TNF-α） and interleukin 6（IL-6） levels were measured on 1st,4th and 7th day in both groups.Results：The results of blood gas analysis and serum TNF-α,IL-6 levels were not different in both groups before therapy（P0.05）.The results of blood gas anslysis in Group B were higher than those of Group A after treatment（P0.05）.TNF-α and IL-6 in Group B decreased more significantly than those of Group A at 4th and 7th day after treatment（P0.05）.The incidence rate of acute respiratory distress syndrome（ARDS） in Group B was lower than that of Group A（P0.05）.Conclusions：High dose dexamethasone combined with Ulinastatin can inhibit the production of inflammatory cytokines significantly and protect lung function effectively in patients with sever pulmonary contusion.

关 键 词：地塞米松 乌司他丁 肺挫伤 治疗 

分 类 号：R563.9[医药卫生—呼吸系统]