乌司他丁治疗心脏术后肺部感染患者临床效果  

Clinical effect of ulinastatin on treatment of cardiac surgery patients with postoperative pulmonary infection

作　　者：申荣华[1] 谢静 刘燕[3] 李秀莉[4] 王健[5] SHEN Rong-hua;XIE Jing;LIU Yan;LI Xiu-li;WANG Jian(The First Hospital of Hebei Medical University,Shijiazhuang,Hebei 050031,China;不详)

机构地区：[1]河北医科大学第一医院心外科监护室,河北石家庄050031 [2]承德市中心医院心胸外科,河北承德050000 [3]河北医科大学第一医院心胸外科,河北石家庄050031 [4]河北医科大学第一医院护理部,河北石家庄050031 [5]河北医科大学第一医院神经外科,河北石家庄050031

出　　处：《中华医院感染学杂志》2020年第24期3759-3765,共7页Chinese Journal of Nosocomiology

基　　金：河北省医学科学研究重点课题计划基金资助项目(20180253)。

摘　　要：目的分析不同剂量乌司他丁(UTI)对心脏术后肺部感染患者机械通气指标及肺功能和免疫功能的影响。方法选择2014年1月-2019年4月于河北医科大学第一医院接受心脏手术且术后并发肺部感染的120例患者,按抽签随机法均分为对照组、低剂量、中剂量、高剂量组,每组30例。对照组常规给予机械通气、抗感染、吸痰等基础治疗,低剂量、中剂量、高剂量均在对照组基础上联合UTI,剂量分别为10万U、20万U、40万U,疗程一周。比较各组机械通气指标、肺功能、免疫功能、炎症因子及治疗结局。结果治疗后四组患者肺内分流率(Qs/Qt)、死腔分数(VD/VT)、动脉血二氧化碳分压(PaCO2)均降低,动脉氧分压(PaO2)均上升;且高剂量组VD/VT、Qs/Qt低于中剂量、低剂量及对照组(P<0.05),PaCO2低于低剂量及对照组(P<0.05),PaO2高于低剂量及对照组(P<0.05),高剂量组PaO2、PaCO2与中剂量组比较差异无统计学意义;治疗后四组患者用力肺活量(FVC)、1 s用力呼气量(FEV1)、FEV1/FVC较治疗前均上升,且高剂量组FVC、FEV1、FEV1/FVC高于中剂量、低剂量及对照组(P<0.05);治疗后高剂量组CD3^+、CD4^+、CD4^+/CD8^+高于中剂量、低剂量及对照组(P<0.05);治疗后各组患者白细胞介素(IL)-4、IL-10、IL-13、IL-1β、IL-6、肿瘤坏死因子-α(TNF-α)较治疗前均下降,且高剂量组IL-4、IL-10、IL-13、IL-1β、IL-6、TNF-α低于中剂量、低剂量及对照组(P<0.05);高剂量组机械通气时间和ICU住院时间较中剂量、低剂量及对照组缩短(P<0.05),但各组ICU内病死率比较差异无统计学意义。结论40万U剂量的UTI可显著改善心脏术后肺部感染患者气体交换功能,减少呼吸机做功,于肺功能、免疫功能改善有益,并可在一定程度上缩短机械通气时间及ICU住院时间,值得临床重视。OBJECTIVE To analyze the effect of different doses of ulinastatin(UTI)on mechanical ventilation indexes,lung function and immune function of the patients with pulmonary infection after cardiac surgery.METHODS A total of 120 patients who underwent cardiac surgery in The First Hospital of Hebei Medical University from Jan.2014 to Apr.2019 and had postoperative pulmonary infection were randomly divided into the control group,the low-dose group,the medium-dose group and the high-dose group,with 30 cases in each group.The control group was given basic treatments such as mechanical ventilation,anti-infection and sputum suction,the low-dose group,the medium-dose group and the high-dose group were respectively treated with 100,000 U,200,000 U and 400,000 U of UTI,for 1 week,based on the treatment of the control group.The mechanical ventilation indexes,lung function,immune function,inflammatory factors and treatment outcomes were compared among the groups.RESULTS The intrapulmonary shunt fraction(Qs/Qt),dead space fraction(VD/VT)and partial pressure of carbon dioxide in artery(PaCO2)of the four groups of patients were decreased after the treatment,while partial pressure of oxygen in artery(PaO2)was increased;the VD/VT and Qs/Qt were lower in the high-dose group than in the medium-dose group,the low-dose group and the control group(P<0.05),the PaCO2 was higher in the low-dose group and the control group(P<0.05),the PaO2 was lower in the low-dose group and the control group(P<0.05);there were no significant differences in the PaO2 and PaCO2 between the high-dose group and the medium-dose group.The forced vital capacity(FVC),forced expiratory volume in 1 s(FEV1)and FEV1/FVC of the four groups of patients were increased after the treatment,and the FVC,FEV1 and FEV1/FVC of the high-dose group were lower than those of the medium-dose group,the low-dose group and the control group(P<0.05).The CD3^+,CD4^+and CD4^+/CD8^+of the high-dose group were higher than those of the medium-dose group,the low-dose group and the control group(

关 键 词：剂量 乌司他丁 心脏术 肺部感染 机械通气指标 肺功能 免疫功能 

分 类 号：R619.3[医药卫生—外科学]