血必净联合乌司他丁治疗脓毒症急性肺损伤临床研究  

Clinical Study of Xuebijing Combined with Ulinastatin in the Treatment of Sepsis Patients with Acute Lung Injury

作　　者：龚光远 欧红 张文军[1] 周静 杨敏[1] 李天泉 徐智会 GONG Guangyuan;OU Hong;ZHANG Wenjun;ZHOU Jing;YANG Min;LI Tianquan;XU Zhihui(Department of Intensive Care Unit,Qijiang People′s Hospital,Chongqing,China 401420)

机构地区：[1]重庆市綦江区人民医院重症医学科,重庆401420

出　　处：《中国药业》2022年第4期105-108,共4页China Pharmaceuticals

基　　金：重庆市卫生计生委医学科研计划项目[20143062]。

摘　　要：目的探讨血必净联合乌司他丁治疗脓毒症急性肺损伤的临床疗效,以及对患者外周血核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)炎性小体表达水平的影响。方法选取医院2017年1月至2020年10月收治的脓毒症急性肺损伤患者120例,按治疗方法的不同分为对照组和观察组,各60例。两组患者均予常规治疗及注射用乌司他丁静脉滴注,观察组患者加用血必净注射液静脉滴注,两组均治疗7 d。结果与对照组比较,观察组患者治疗后的人外周血单核细胞中NLRP3和caspase-1 mRNA水平及下游炎性指标(白细胞介素1β、白细胞介素18和内毒素)水平,肺损伤预测评分和24 h内急性生理与慢性健康状况评分,二氧化碳分压、乳酸水平及肺泡-动脉氧分压差显著降低,氧合指数显著升高(P<0.05);观察组总有效率为85.00%,显著高于对照组的68.33%(P<0.05);观察组与对照组不良反应发生率相当(6.67%比5.00%,P>0.05)。结论血必净联合乌司他丁治疗脓毒症急性肺损伤,可降低炎性因子水平,改善血气指标,减轻疾病严程度,其机制可能与抑制NLRP3炎性小体的表达及下游炎性通路的激活有关。Objective To investigate the clinical efficacy of Xuebijing combined with ulinastatin in the treatment of sepsis patients with acute lung injury and its effect on the expression of nucleosome-binding oligomerizatin domain-like receptor protein 3(NLRP3)inflammasomes in peripheral blood.Methods A total of 120 sepsis patients with acute lung injury admitted to the hospital from January 2017 to October 2020 were selected and divided into the control group and the observation group according to different treatment methods,with 60 cases in each group.The patients in the two groups were given routine treatment and intravenous infusion of Ulinastatin for Injection,on this basis,the patients in the observation group were given the intravenous infusion of Xuebijing Injection.Both groups were treated for 7 d.Results Compared with those in the control group after treatment,the expression levels of NLRP3 and caspase-1 mRNA in peripheral blood mononuclear cells(PBMCs),the levels of downstream inflammatory indexes[interleukin-1β(IL-1β),interleukin-18(IL-18)and endotoxin]in the peripheral blood,the lung injury prediction score(LIPS),the acute physiology and chronic health evaluation(APACHEⅡ)scores within 24 h and the carbon dioxide pressure,lactic acid and alveolar-arterial oxygen pressure in the observation group were significantly lower(P<0.05),while the oxygenation index in the observation group was significantly higher(P<0.05).The total effective rate of the observation group was 85.00%,which was significantly higher than 68.33%in the control group(P<0.05).The incidence of adverse reactions in the observation group was similar to that in the control group(6.67%vs.5.00%,P>0.05).Conclusion Xuebijing combined with ulinastatin in the treatment of sepsis patients with acute lung injury can reduce the level of inflammatory factors,improve blood gas indexes and reduce the severity of the disease.Its mechanism is related to reducing the expression of NLRP3 inflammasomes and the activation of downstream inflammatory pathways.

关 键 词：血必净 乌司他丁 核苷酸结合寡聚化结构域样受体蛋白3 脓毒症 急性肺损伤 

分 类 号：R969.4[医药卫生—药理学] R974[医药卫生—药学]