乌司他丁对重型创伤性脑损伤患者颈内静脉血乳酸的影响  

Effect of ulinastatin on jugular venous lactic acid in patients with severe traumaticbrain injury

作　　者：李国民[1] 万健 袁冬[1] 王建强[1] 管双仙[1] 

机构地区：[1]江苏大学附属金坛医院ICU,江苏金坛213200 [2]上海瑞金医院集团闵行医院急诊,ICU,201100

出　　处：《中华危重症医学杂志（电子版）》2012年第2期20-23,共4页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：江苏省金坛市科技计划项目(TS2006063);江苏省金坛市"133人才培养工程"项目(20070202)

摘　　要：目的探讨乌司他丁(UTI)对重型创伤性脑损伤患者颈内静脉血乳酸及脑氧代谢的影响及其临床意义。方法选择80例重型创伤性脑损伤患者(格拉斯哥昏迷量表评分≤8分),分为研究组和对照组,每组各40例。研究组在常规综合治疗基础上予UTI20万单位,每日2次,连续7d。所有患者均于伤后第1～5天取颈内静脉球血和桡动脉血作乳酸检测和血气分析,观察颈静脉血乳酸(JVL)、颈静脉血氧饱和度(SjvO2)、动脉颈静脉血氧含量差(A-vDO2)、脑氧摄取率(CERO2)等指标。结果两组患者伤后第1天JVL均高于正常值,组间比较差异无统计学意义(P=0.60)。伤后第2～5天,研究组JVL水平与第1天比较均明显下降(P均<0.05),且较同时间点对照组下降更为明显(P均<0.05);两组患者伤后第2～5天SjvO2、A-vDO2和CERO2比较,差异均有统计学意义(P均<0.05)。结论 UTI能降低重型创伤性脑损伤患者JVL水平,改善脑氧代谢状况,进而有利于降低患者的病死率和病残率。Objective To investigate the effects of ulinastatin on jugular venous lactic acid and cerebral oxygen metabolism in patients with severe traumatic brain injury. Methods Eighty patients with severe traumatic brain injury and Glasgow coma scale score 〈 8, randomly divided into control group （40 cases） and ulinastatin group （40 cases）. Patients in the control group were treated with conventional therapy, and the patients in the ulinastatin group received ulinastatin intravenous injection for 7 d （200 000 units twice a day） additionly. The blood samples were collected from internal jugular venous bulb and radial artery for blood gas analysis in the two groups from 1st d to 5th d after injury. The jugular venous lactic acid （JVL）, saturation of jugular venous oxygen （SjVO2）, arterial-venous oxygen content difference （A-vDO2） and cerebral oxygen extraction rate （CERO2） were calculated. Results The level of JVL increased on lstd after injury, but showed no significant difference between the two groups （P= 0.60）. In the ulinastation group, the levels of JVL from 2nd d to 5th d after injury decreased as compared with the 1st d （all P 〈 0.05）, and were markedly lower than the controls at corresponding time points （all P 〈 0.05）. Moreover, the SjVO2, A-vDO2 and CERO2 were all significantly different between the two groups from 2nd d to 5th d after injury （all P 〈 0.05）. Conclusion Ulinastatin can decline the level of JVL, ameliorate cerebral oxygen metabolism, and thereby reduce the mortality and disability rate in patients with severe traumatic brain injury.

关 键 词：脑损伤 乌司他丁 乳酸 

分 类 号：R651.15[医药卫生—外科学]