乌司他丁联合支气管镜肺泡灌洗防治大面积烧伤合并呼吸道损伤患者肺部感染的效果及对氧化应激、炎性反应的影响  

Effect of Ulinastatin Combined with Bronchoalveolar Lavage in Prevention and Treatment of Pulmonary Infection in Patients with Extensive Burns and Respiratory Tract Injury and Its Effect on Oxidative Stress and Inflammatory Response

作　　者：刘兰瑞[1] 孙进华[1] 李梅[1] 冉小芳[1] 王香坤 康琼英[2] LIU Lan-rui;SUN Jin-hua;LI Mei;RAN Xiao-fang;WANG Xiang-kun;KANG Qiong-ying(Department of Burns and Plastic Surgery,the Fifth Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Burns and Plastic Surgery,the First Hospital of Hebei Medical University,Shijiazhuang 050031,China)

机构地区：[1]保定市第五医院烧伤整形科,河北保定071000 [2]河北医科大学第一医院烧伤整形科,石家庄050031

出　　处：《临床误诊误治》2020年第3期57-62,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究计题(20191229);河北省医学科学研究重点课题计划项目(20110293)。

摘　　要：目的探讨乌司他丁联合支气管镜肺泡灌洗(bronoho alveolar lavage,BAL)防治大面积烧伤合并呼吸道损伤患者肺部感染的效果及对氧化应激、炎性反应的影响。方法选择2017年10月—2018年11月收治的大面积烧伤合并呼吸道损伤82例,根据治疗方法的不同,分为观察组和对照组,每组各41例。两组均予彻底清创、抗休克、营养支持等常规治疗,在此基础上,观察组于入院第2日给予BAL联合乌司他丁治疗,均治疗2周。观察治疗期间肺部感染发生情况及感染控制时间,检测治疗前及治疗后血气分析相关指标[血氧饱和度(SaO 2)、二氧化碳分压(PaCO 2)、氧分压(PaO 2)]、氧化应激相关指标[丙二醛(malondialdehyde,MDA)、髓过氧化物酶(myeloperoxidase,MPO)、脂质过氧化物(lipid peroxide,LPO)]、炎性因子相关指标[白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子(tumor necrosis factor,TNF)-α、降钙素原(procalcitonin,PCT)]的水平变化,记录不良反应发生情况。结果与对照组比较,观察组肺部感染发生率降低,感染控制时间缩短,差异有统计学意义(P<0.05)。与对照组比较,观察组治疗后PaO 2、SaO 2升高,PaCO 2降低,MDA、MPO、LPO、IL-6、TNF-α及PCT水平下降,差异有统计学意义(P<0.05);与本组治疗前比较,两组治疗后PaO 2、SaO 2升高,PaCO 2下降,MDA、MPO、LPO、IL-6、TNF-α及PCT水平降低,差异有统计学意义(P<0.05)。两组治疗期间均无明显不良反应发生。结论乌司他丁联合BAL防治大面积烧伤合并呼吸道损伤患者肺部感染的效果显著,同时可改善血气分析相关指标,抑制氧化应激反应和炎性反应,有利于改善预后。Objective To investigate the effect of ulinastatin combined with bronchoalveolar lavage(BAL)in the prevention and treatment of pulmonary infection in patients with extensive burns and respiratory tract injury,and its effect on oxidative stress and inflammatory response.Methods Eighty-two cases of extensive burns combined with respiratory tract injury who were admitted from October 2017 to November 2018 were divided into observation group(n=41)and control group(n=41)according to different treatment methods.The two groups were given complete debridement,antishock,nutritional support and other symptomatic treatment.On this basis,the observation group was given BAL combined with ulinastatin on the second day of admission.Both groups were treated for two weeks.The incidence of pulmonary infection and duration of infection control were observed during the treatment.The changes in blood gas analysis indexes[arterial blood oxygen saturation(SaO2),PaCO2,partial pressure of oxygen(PaO2)],oxidative stress related indicators[malondialdehyde(MDA),myeloperoxidase(MPO),lipid peroxide(LPO)]and inflammatory factor related indexes[interleukin-6(IL-6),tumor necrosis factor-alpha(TNF-α),procalcitonin(PCT)]were detected before and after the treatment.In addition,adverse reactions were recorded.Results Compared with the control group,the incidence of pulmonary infection and the duration of infection control in the observation group were decreased significantly(P<0.05).Compared with the control group,PaO 2 and SaO 2 were increased,while PaCO 2,MDA,MPO,LPO,IL-6,TNF-αand PCT were decreased significantly in the observation group(P<0.05).Compared with the same group before treatment,PaO 2 and SaO 2 were increased,PaCO 2,MDA,MPO,LPO,IL-6,TNF-αand PCT were decreased significantly in the two groups after treatment(P<0.05).There were no significant adverse reactions in the two groups.Conclusion Ulinastatin combined with BAL has a significant effect in the prevention and treatment of pulmonary infection in patients with extensive burns and r

关 键 词：烧伤 乌司他丁 支气管肺泡灌洗 肺部感染 丙二醛 髓过氧化物酶 肿瘤坏死因子α 

分 类 号：R644[医药卫生—外科学]