乌司他丁对竹叶青蛇伤致DIC的影响  

Effect of Ulinastatin on DIC caused by Trimeresurus medoensis

作　　者：侯杰[1] 周岁锋[1] 刘芳芳[1] 苏立成[1] 赖贵龙 刘锦文[1] 

机构地区：[1]广州中医药大学附属中山市中医院急诊科,广东中山528400

出　　处：《临床急诊杂志》2015年第1期15-17,共3页Journal of Clinical Emergency

摘　　要：目的:观察乌司他丁(Ulinastatin,UTI)对竹叶青蛇伤致DIC的影响。方法:用前瞻性随机对照研究方法将15例竹叶青蛇伤患者分为常规组、UTI60WU组、UTI40WU组。常规组就诊后即予清创局封、静滴抗蝮蛇毒血清、根据需要输注新鲜冰冻血浆、对症支持治疗。UTI60WU组和UTI40WU组在常规治疗的基础上,分别加用UTI20WU+0.9%氯化钠20ml静脉注射,Q 8h及Q 12h,疗程均为1d。分别观察在治疗后0、1、3、5、7d血小板(PLT)、纤维蛋白原(Fib)、凝血酶原时间(PT)和D二聚体(D-D)的动态变化,DIC评分,以及出血、肝肾功能变化等。结果:3组凝血指标的变化趋势高度一致,其中Fib的下降无明显统计学差异,PT随病程发展而延长,二者与DIC评分的变化高度吻合,均在3d时表现为最差值;D-D在入院时即升高,并在伤后1d达峰值,7d时所有指标均未恢复正常。60WU组的DIC评分及D-D值与常规组比较差异有统计学意义,但在病程极期不再有差异,40WU组无此改变。结论:大剂量乌司他丁具有减轻DIC程度的作用,但不能阻断或缩短DIC的发生,总体来说,静脉用乌司他丁对竹叶青蛇伤DIC疗效仍不理想。Objective：To investigate the effect of Ulinastatin on DIC caused by trimeresurus medoensis. Method： 15 in-patients of trimeresurus medoensis were divided into 3 groups with prospective,random method：common group,UTI60wu group and UTI40wu group. Based on common treatment,UTI60wu group and UTI40wu group were respectively received UTI20wu＋0.9%NS 20 ml IV,Q8 h and Q12 hX 1 day,DIC scoring criteria and DIC- related indicators（PLT, Fib,PT and D-D） in 0,1,3,5,7day after treatment were recorded. Result：Such DIC-related indicators as Fib,PT and D--D in 3 groups had the same change trendency with the worest in 3th day. D-D was a- bove normal at admission and reached top peak at 1st day. All of them hadnot restored to normal. There were significant differences in DIC scoring criteria and D-D level between common group and UTI60wu group, but disap- peared at peak time. UTI40wu group wasnot so. Conclusion： High dosage of Ulinastatin can reduce DIC degree,but cannot stop or shorten DIC. Overall, the effect of Ulinastatin by iv on DIC caused by Trimeresurus medoensis is dissatisfactory.

关 键 词：竹叶青蛇 DIC DIC评分 乌司他丁 

分 类 号：R595[医药卫生—内科学]