严重脓毒症性急性呼吸窘迫综合征患者血管外肺水的变化以及乌司他丁的作用  

Changes of Extravascular Lung Water and Effects of Ulinastatin in Serious Septic Patients with ARDS

作　　者：何超[1] 黄增相[2] 陶骅[2] 徐雯[2] 徐迅科[2] 金姝[2] 魏建东[2] 张健[2] 李文放[1] 林兆奋[1] 

机构地区：[1]第二军医大学附属长征医院急救科,上海200003 [2]上海市普陀区人民医院急诊科,上海200062

出　　处：《中国呼吸与危重监护杂志》2015年第3期291-294,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：上海市普陀区卫生系统自主创新科研项目(编号:普KW12305);广东省药学会天普研究基金(编号:01201018)

摘　　要：目的动态观察严重脓毒症性急性呼吸窘迫综合征(ARDS)患者血管外肺水指数(ELWI)水平,了解严重脓毒症性ARDS患者ELWI的变化,通过对照研究给予乌司他丁(UTI)注射液,观察干预前后严重脓毒症患者ELWI的变化。方法选择2010年1月至2012年12月第二军医大学附属长征医院急救科重症监护病房(ICU)符合严重脓毒症性ARDS诊断标准的48例患者作为研究对象,通过脉波指示剂连续心排出量监测(PICCO)测定ELWI,并结合氧合指数(Pa O2/Fi O2)等了解肺损伤程度。按照随机原则分为UTI组(n=30)和对照组(n=18),两组患者均给予常规的综合治疗措施,UTI组在此基础上加用UTI 3万U·kg-1·d-1静脉滴注,分为4次使用,连用3 d,观察治疗前后患者的ELWI、Pa O2/Fi O2、Murray评分、急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、序贯器官衰竭评分(SOFA)以及28 d死亡率。结果 UTI组与对照组患者治疗前的APACHEⅡ评分、Murray评分及SOFA评分比较差异均无统计学意义(P>0.05);治疗第4和7 d两组患者的各项评分较治疗前均下降,差异有统计学意义(P<0.05)。UTI组与对照组患者治疗前均伴有不同程度的Pa O2/Fi O2下降,ELWI增高,差异无统计学意义(P>0.05);治疗后两组患者Pa O2/Fi O2升高,ELWI浓度下降,差异有统计学意义(P<0.05)。UTI组与对照组患者28 d生存率(90.0%比66.7%)及死亡率(10.0%比33.3%)比较,差异有统计学意义(P<0.05)。结论严重脓毒症发生ARDS患者均伴有不同程度的ELWI增高及Pa O2/Fi O2下降,常规治疗上加用UTI注射液能够降低严重脓毒症性ARDS患者的ELWI,改善临床症状,降低28 d死亡率。Objective To observe the level of extravascular lung water index （ELWI） in serious septic patients with ARDS,and the effects of ulinastatin （UTI） on ELWI. Methods A perspective control study was performed on 48 severe septic patients with ARDS from the emergency department and ICU in Shanghai Changzhen Hospital from January 2010 to December 2012. Pulse indicator continuous cardiac output （PICCO） technique was utilized for measuring ELWI. Meanwhile the oxygenation index （PaOJ FiO2 ） was detected. The patients were randomized as an UTI group （n =30） and a control group （n = 18）. Both groups received routine comprehensive treatments, and the UTI group additionally received 30 000 units/kg UTI intravenous drip 4 times a day for continuous 3 days. The PaO2/FiO2, ELWI, Murray lung injury score, APACHEⅡ score, SOFA score and 28-day mortality were determined. Results The APACHE Ⅱ score, Murray and SOFA score had no statistical difference between the UTI group and the control group before treatment （ P 〉 0. 05 ）, and decreased significantly after 4 and 7 days of treatment in both groups compared with those before treatment （P 〈 O. 05 ）. There were varying degrees of PaO2/FiO2 decrease and ELWI increase before treatment in both groups with no significant difference between two groups （P 〉 0. 05）. After treatment, the FaOJFiO2 increased and ELWI decreased in both groups, and the UTI group had better PaO2/FiO2 and ELWI than the control group （ P 〈 0. 05 ）. The difference in 28-day mortality between the UTI group and the control group was statistically significant （10. 0% vs. 33.3%, P 〈 0. 05 ）. Conclusions Severe septic patients with ARDS are all complicated with ELWI increase. Routine therapy combined with UTI can decrease ELWI,improve clinical symptoms, and decrease 28-day mortality.

关 键 词：急性呼吸窘迫综合征 乌司他丁 血管外肺水 脉波指示剂连续心排出量监测 

分 类 号：R459.7[医药卫生—急诊医学]