乌司他丁在预防急性呼吸窘迫综合征中的作用  

Preventive effects of ulinastatin on acute respiratory distress syndrome

作　　者：贾丽静[1,2] 易亮[3] 杨志旭[3] 王书鹏[4] 李刚[4] 朱曦[1] 

机构地区：[1]北京大学第三医院危重医学科,北京100191 [2]沧州市人民医院重症医学科,河北沧州061000 [3]中国中医科学院西苑医院重症医学科,北京100091 [4]中日友好医院重症医学科,北京100029

出　　处：《北京大学学报（医学版）》2016年第4期672-679,共8页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(81372043);首都医学发展科研基金(2009-1014);北京市自然科学基金(7162199);天普研究基金(01201113)资助~~

摘　　要：目的:探讨乌司他丁对预防急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的作用。方法:采用前瞻性随机对照试验,选择2012年1月至2014年12月北京大学第三医院危重医学科、沧州市人民医院、中国中医科学院西苑医院和北京中日友好医院重症医学科的185例患者,随机分为干预组(n=77)和对照组(n=108)。两组患者均接受常规治疗,干预组患者入重症监护病房(intensive care unit,ICU)后在常规治疗基础上每天加用乌司他丁60万单位,静脉输注,连用5 d;对照组静脉输注等体积生理盐水,连续5 d。于干预的第1、3、7天分别检测静脉血中性粒细胞弹性蛋白酶(human neutrophil elastase,HNE)和中性粒细胞弹性蛋白酶抑制剂(peptidase inhibitor 3,PI3)的水平,计算HNE/PI3比值,监测患者急性生理学及慢性健康状况评分(acute physiology and chronic health evaluation scoringⅡ,APACHEⅡ)、体温、呼吸频率、心率、平均动脉压、白细胞计数、氧合指数(Pa O2/Fi O2),并记录两组患者ARDS发生率、机械通气时间、ICU治疗时间、住院时间及28 d生存率。结果:两组患者在性别、年龄、APACHEⅡ评分、吸烟情况、基础疾病情况、入院诊断等方面差异无统计学意义。两组患者的3次HNE检测值比较(第1、3、7天)差异均无统计学意义,两组患者第1天PI3检测值比较差异无统计学意义,第3天及第7天PI3的检测值比较差异均有统计学意义(P<0.01);两组患者第1天HNE/PI3比值比较差异无统计学意义,第3天及第7天的HNE/PI3比值差异有统计学意义(P<0.05)。两组患者在第1、3、7天的体温、呼吸频率、心率、平均动脉压、白细胞计数方面的比较差异均无统计学意义;两组患者第1天的氧合指数比较差异无统计学意义,第3天及第7天的氧合指数比较差异有统计学意义(P<0.05)。干预组患者ARDS的发生率为15.58%,明显低于对照组的33.33%,差异有统计学意义(P<0.05)。在�Objective ： To explore the effect of ulinastatin on prevention of acute respiratory distress syndrome （ARDS）. Methods： A prospective multieentral eohort study was conducted. The patients from three intensive care units （ICUs） of grade A tertiary hospitals in Beijing and a ICU of grade A tertiary hospitals in Cangzhou from January 2012 to December 2014, included 77 ARDS at-risk patients with ulinastatin treatment and 108 ARDS at-risk patients without ulinastatin treatment （control） were eligible. Both groups received normal treatment ; additionally, the intervention group received 600 000 units of uli- nastatin via intravenous infusion for 5 days. The control group received the same amount of saline via intravenous infusion for 5 days. Venous blood human neutrophil elastase （HNE） and peptidase inhibitor 3 （ PI3 ） levels were measured on days 1, 3, and 7, respectively. Other outcomes included acute physiology and chronic health evaluation scoring Ⅲ （APACHE Ⅱ ）, body temperature, respiratory rate, heart rate, mean arterial pressure, white blood cell counts, PaO2/Fi02, ARDS incident, mechanical ventila-tion time, 1CU treatment and hospitalization duration, 28 days mortality. Results： The PI3 levels showed no statistical difference on day 1, but significant differences on day 3 and day 7 between the two groups （P 〈0.01 ）. HNE/PI3 ratio showed no statistical difference on day 1, but significant differences on day 3 and day 7 （P 〈 0.05 ）. PaO2/FiO2 was significantly higher in ulinastatin group on day 3 and day 7 （P 〈0.05）. The incident rate for ulinastatin group was 15.58% , lower than that for the control group （33.33%）, and the difference was statistically significant （P 〈0.05）. The mechanical ventilation time and ICU treatment time in ulinastatin group was shorter than that in the control group, and the difference was statistically significant （P 〈 0.05 ）. There were no significant effects in other factors. Conclusion： Increased dose of ulinastatin

关 键 词：乌司他丁 呼吸窘迫综合征 成人 白细胞弹性蛋白酶 

分 类 号：R563.8[医药卫生—呼吸系统]