乌司他丁对吸入性损伤患者早期肺功能的保护作用  

Protective effects of ulinastatin on early pulmonary function of patients with burn and smoke inhalation injury

作　　者：丁伟[1] 吕大伦[1] 徐祥[1] 王合丽[1] 王箴[2] 

机构地区：[1]皖南医学院附属弋矶山医院烧伤整形科,安徽芜湖241001 [2]皖南医学院附属弋矶山医院重症医学科,安徽芜湖241001

出　　处：《皖南医学院学报》2014年第3期224-227,共4页Journal of Wannan Medical College

摘　　要：目的:研究乌司他丁(ulinastatin)对吸入性损伤患者早期炎症反应的影响及肺功能保护作用。方法:43例重症烧伤合并吸入性损伤患者,随机分为乌司他丁治疗组(21例)和对照组(22例),两组常规治疗一致,乌司他丁组在此基础上给予1万U/(kg·d)静脉滴注,连续用药7 d。分别于治疗开始前、治疗后第1天、第4天、第7天检测血气分析指标、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、过氧化物歧化酶(SOD)含量,并记录第1天、第4天、第7天、第14天患者APACHEⅡ评分及治疗14 d内肺部感染发生情况。结果:与对照组相比,乌司他丁治疗后第4天、第7天,动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、IL-10、SOD明显升高,TNF-α、IL-6明显下降,差异均有统计学意义(P<0.05);治疗后第7天CRP明显下降,差异有统计学意义(P<0.05);治疗14 d内各时间点两组患者APACHEⅡ评分差异无统计学意义;乌司他丁治疗组肺部感染发生率较低,发生时间较迟。结论:吸入性损伤早期采用乌司他丁回补策略作为一种有效的辅助治疗方式,可减轻患者的炎症反应,改善呼吸功能,减少肺部感染发生。Objective： To observe the effects of ulinastatin on inflammatory response and early pulmonary function in the patients with burn and smoke inhalation injury. Methods： Forty-three patients with severe inhalation injury were randomly allocated to the experimental group（ n = 21） and control group（ n =22）. Two groups of patients received conventional therapy of burn injury,and the experimental group were given additional intravenous drip of ulinastatin in dose of 10 000 U /（ kg·d） for 7 days. Before treatment and at day 1,4 and 7 after treatment,blood samples were taken from peripheral veins for determination of C-reactive protein（ CRP）,TNF-α,IL-6,IL-10 and SOD activities. Besides,APACHEⅡ scoring was maintained at day 1,4,7 and 14,respectively,for evaluation of the incidence of pulmonary infection in the two groups. Results： By comparison with the control group at day 4 and 7 after treatment,significantly elevated PaO2,PaO2/FiO2,IL-10 and SOD,yet markedly reduced TNF-α and IL-6 levels were observed in patients from experimental group,and the CRP level was also significantly lowed,which showed statistical difference（ P〈0. 05）. Although the APACHEⅡ scores had no significant difference between two groups,the experimental group had lower incidence rate and delayed occurrence of pneumonia within 14 days of therapy.Conclusion： Complementary therapy with ulinastatin during the early phase may effectively inhibit the inflammatory response,improve the pulmonary function and reduce the incidence of pneumonia for patients with burn and smoke-induced inhalation injury.

关 键 词：乌司他丁 吸入性损伤 早期肺功能 保护 

分 类 号：R644[医药卫生—外科学]