血必净注射液联合乌司他丁对脓毒症合并ARDS患者肺血管通透性的临床疗效研究  

Clinical study of effect of Xuebijing injection combined with Ulinastatin on sepsis acute respiratory distress syndrome patients'pulmonary vascular permeability

作　　者：刘源 梅建强 施保柱 李岩涛 许梅 杨明华 王灿 Liu Yuan;Mei Jianqiang;Shi Baozhu;Li Yantao;Xu Mei;Yang Minghua;Wang Can(Intensive Care Unit,Hebei Traditional Chinese Medicine Hospital,Hebei University of Chinese Medicine,Shijiazhuang 050013,Hebei,China;Department of Emergency,Hebei Traditiomd Chinese Medicine Hospital,Hebei Universily of Chinese Medicine,Shijiazhuang 050013,Hebei,China)

机构地区：[1]河北中医学院河北省中医院重症医学科,河北石家庄050013 [2]河北中医学院河北省中医院急诊科,河北石家庄050013

出　　处：《中国中西医结合急救杂志》2021年第4期385-389,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河北省中医药管理局中医药类科研计划项目(2019042)。

摘　　要：目的观察血必净注射液联合乌司他丁对脓毒症合并急性呼吸窘迫综合征(ARDS)患者肺血管通透性的改善效果。方法选择2019年1月至2020年6月河北省中医院急诊及重症监护病房(ICU)收治的70例脓毒症合并ARDS患者作为研究对象,采用随机数字表法分为对照组和研究组,每组各35例。对照组在按照指南标准治疗的基础上给予乌司他丁20×10^(4)U静脉注射(12h 1次);研究组在对照组基础上加用血必净注射液100 ml,静脉滴注(12h 1次)。所有患者均以5d为1个疗程。检测两组患者治疗前及治疗5d的B线评分、支气管肺泡灌洗液(BAILF)蛋白含量.血管通透性相关因子[内皮素-1(ET-1)、血栓调节蛋白(TM)、血管性血友病因子(WF)]以及血气分析指标[氧合指数(PaO_(2)/F0_(2))、肺泡-动脉血氧分压差(PA-a0_(2))]。观察两组患者28d生存率、住院时间、机械通气时间以及急性生理学与慢性健康状况评分Ⅱ(APACHE Ⅱ)和序贯器官衰竭评分(SOFA)。结果治疗后,两组患者B线评分、BALF蛋白含量以及ET-1、TM和vWF水平均较治疗前降低。且研究组明显低于对照组[B线评分(分):13.57±1.85比19.23±1.76,BALF蛋白含量(g/L):1.53±0.42比1.98±0.45,ET-1(ng/L):116.37±27.76比152.26±28.16.TM(μg/L):15.73±4.71比19.18±4.77,vWF(ng/L):80.51±14.13比102.83±14.77.均P<0.05];两组患者PaO/FiO_(2)均较治疗前升高,PA-aO_(2)均较治疗前降低,且研究组较对照组变化更明显[PaO/FiO_(2)(mmHg.1 mmHg=0.133 kPa):271.43±19.61比237.32±19.76,PA-a0_(2)(mmHg):147.78±13.86比182.39±14.72.均P<0.05]。与对照组比较.研究组患者28d生存率明显升高,住院时间和机械通气时间均明显缩短[28 d生存率:85.71%(30/35)比60.00%(21/35),住院时间(d):25.27±4.36比31.28±4.41,机械通气时间(d):16.58±1.35比23.45±1.28,均P<0.05]。两组患者治疗后APACHE Ⅰ评分和SOFA评分均较治疗前降低,且以研究组降低更明显[APACHE Ⅱ评分(分):11.21±3.35比14.47±3.27.SOFAObjective To observe the effect of Xuebijing injetion combined with Ulinastatin on the improvement of pulmonary vasrular permeability in sepsis arule respiratory distress syndromr(ARDS).Methods From Jamuary 2019 to June 2020.70 patients with sepsis ARDS admitted to the department of emergency and intensivr care unit(ICU)of Hehei Traditional Chinese Medicine Hospital werr selected as the rsrarch objerts.The random mumber table method was used to divide the patients into control group and study group.with 35 cases in each group.The control group was treated with Ulinastatin 20×10^(4)U by intravenous injetion(once every 12 hours)on the basis of standard treatment according to the guidelines:the study group was treated with Xuebjing injection 100 ml.by intravenous drip injection(once every 12 hours)on the basis of the control group.All patients took 5 days as a course of treatment.Before treatment and 5 days after treatment,the two groups of patients wer testerd for B-line score,protein content in bronchoalveolar lavage fluid(BALF),vasrular prmalbiliy-related farctors[endothelin-1(ET-1).thrombomodulin(TM).von Wilebrand factor(vWF)]and blod gas analysis indicators lorygenation index(PaO_(2)/Fi0_(2)).alvelar-arterial oxygern partial pressure dfferere(PA-aO_(2)). The 28-lay surnival mate.hopitalization timr.mochanical venilation time,arute physidogy and chnonie hrealth ealuation Ⅱ(APACHE Ⅱ)and sequential organ failure assrssment(SOFA)of the two groups were ohserved.Results After treatment.the level of B-ine srorr,protein content in BAILF and ET-1.TM and vWF of the Iwo groups of patients werr lower than those before treatment,and the levels in the study group wer signifranly lower than those of the control group[B-line srore:13.57±1.85 vs.19.23±1.76.protein content in BALF(g/L);1.53±0.42 vs.1.98±0.45.ET-1(n/L);:116.37±27.76vs.152.26±28.16.TM(u/L:15.73±4.71 vs.19.18±4.77.vWF(ng/L):80.51±14.13 vs.102.83±14.77.all P<0.05];in 1two groups.after treatment.the levels of PaO/FiO2 of the patiernts werr higher than

关 键 词：血必净注射液 乌司他丁 脓毒症 急性呼吸窘迫综合征 肺血管通透性 

分 类 号：R47[医药卫生—护理学]