乌司他丁联合前列地尔辅助治疗脓毒症所致急性呼吸窘迫综合征的临床疗效及预后  

Clinical Efficacy and Prognosis of Ulinastatin Combined with Alprostadil in the Adjuvant Treatment of Acute Respiratory Distress Syndrome Induced by Sepsis

作　　者：向海[1] 刘翠华[2] XIANG Hai;LIU Cuihua(Dept.of Respiratory and Critical Care,Mianyang Central Hospital,Sichuan Mianyang 621000,China;Dept.of Emergency,Mianyang Central Hospital,Sichuan Mianyang 621000,China)

机构地区：[1]绵阳市中心医院呼吸与危重症科,四川绵阳621000 [2]绵阳市中心医院急诊医学科,四川绵阳621000

出　　处：《中国医院用药评价与分析》2021年第6期678-681,686,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：四川省科技计划重点项目(No.2018SZS01831)。

摘　　要：目的:探讨乌司他丁联合前列地尔辅助治疗脓毒症所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床疗效以及对预后的影响。方法:选取2018年2月至2020年3月绵阳市中心医院收治的脓毒症所致ARDS患者79例,采用随机数字表法分为观察组(40例)和对照组(39例)。对照组患者给予乌司他丁治疗7 d,观察组患者给予乌司他丁联合前列地尔治疗7 d。比较两组患者的机械通气时间、住院时间、急性生理学和慢性健康状况评价Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分和序贯器官衰竭评估(sequential organ faliure assessment,SOFA)评分、炎症因子、凝血指标、血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)、不良反应以及28 d生存率的差异。结果:观察组患者机械通气时间、住院时间明显短于对照组,治疗7 d时的APACHEⅡ评分、SOFA评分明显低于对照组,差异均有统计学意义(P <0.05)。两组患者治疗3、7 d时动脉二氧化碳分压(Pa CO2)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、D-二聚体、纤维蛋白原(Fib)、EVLWI及PVPI均逐渐降低,动脉氧分压(Pa O2)、氧合指数(Pa O2/Fi O2)逐渐升高,与治疗前比较,差异均有统计学意义(P <0.05);观察组患者治疗3、7 d时的Pa O2、Pa O2/Fi O2明显高于对照组,Pa CO2、CRP、TNF-α、D-二聚体、Fib、EVLWI及PVPI明显低于对照组,差异均有统计学意义(P <0.05)。观察组患者住院28 d存活率为82.50%(33/40),明显高于对照组的58.97%(23/39),差异有统计学意义(Log-Rank检验,χ2=5.771,P=0.016)。结论:乌司他丁联合前列地尔辅助治疗脓毒症所致ARDS,可有效抑制炎症反应,降低血液黏滞度和肺血管通透性,纠正低氧血症,缩短机械通气时间和住院时间,改善患者预后。OBJECTIVE: To probe into the clinical efficacy of ulinastatin combined with alprostadil in the adjuvant treatment of acute respiratory distress syndrome( ARDS) induced by sepsis and its effects on prognosis. METHODS:Totally 79 patients with ARDS induced by sepsis admitted into Mianyang Central Hospital from Feb. 2018 to Mar.2020 were extracted to be divided into the observation group( n = 40) and the control group( n = 39) via the random number table. The control group was treated with ulinastatin for 7 d,while the observation group received ulinastatin combined with alprostadil for 7 d. The duration of mechanical ventilation,length of stay,acute physiology and chronic health evaluationⅡ( APACHEⅡ) score and sequential organ faliure assessment( SOFA) score,inflammatory factors,coagulation parameters,extravascular lung water index( EVLWI) and pulmonary vascular permeability index( PVPI),adverse drug reactions,and 28-d survival of two groups were compared. RESULTS: The duration of mechanical ventilation and length of stay in the observation group were significantly shorter than those in the control group,and the APACHEⅡ score and SOFA score on the 7 th d of treatment were significantly lower than those in the control group,with statistically significant differences( P < 0. 05). Arterial partial pressure of carbon dioxide( PaCO2),C-reactive protein( CRP),tumor necrosis factor-α( TNF-α),D-dimer,fibrinogen( Fib),EVLWI and PVPI in two groups decreased significantly on the 3 rd and 7 th of treatment,and the arterial partial pressure of oxygen( PaO2) and oxygenation index( PaO2/Fi O2) increased,the differences were statistically significant compared with those before treatment( P < 0. 05). The PaO2,PaO2/Fi O2 of the observation group were significantly higher than those of the control group on the 3 rd and 7 th day of treatment,PaCO2,CRP,TNF-α,D-dimer,Fib,EVLWI and PVPI were significantly lower than those of the control group,the differences were statistically significant( P < 0. 05). The survival of patients in

关 键 词：乌司他丁 前列地尔 脓毒症 急性呼吸窘迫综合征 

分 类 号：R977.1[医药卫生—药品]