乌司他丁联合无创机械通气对SAP并发ARDS患者血气指标、肝肾功能和肠黏膜功能的影响

摘要 目的：探讨乌司他丁联合无创机械通气对重症急性胰腺炎（severe acute pancreatitis，SAP）并急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）患者血气指标、肝肾功能和肠黏膜功能的影响。方法：选取2015年1月~2020年1月期间青海省中医院收治的73例SAP并发ARDS患者。根据随机数字表法分为对照组（n=36）和研究组（n=37），对照组患者予以无创机械通气治疗，研究组在对照组的基础上联合乌司他丁治疗，比较两组患者疗效、血气指标、肝肾功能指标以及肠黏膜功能指标，记录两组治疗期间不良反应情况。结果：研究组治疗7 d后的临床总有效率为89.19 %（33/37），高于对照组的66.67 %（24/36）（P<0.05）。两组治疗7 d后动脉血氧分压（PaO₂）、氧合指数均较治疗前升高，天冬氨酸氨基转移酶（aspartate aminotransferase，AST）、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、血尿素氮（blood urea nitrogen，BUN）以及血清肌酐（creatinine，Cr）、二胺氧化酶（diamine oxidase，DAO）、D-乳酸、动脉血二氧化碳分压（arterial partial pressure of carbon dioxide，PaCO₂）较治疗前降低，且研究组优于对照组（P<0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：乌司他丁联合无创机械通气治疗SAP并发ARDS患者，疗效显著，可有效改善患者血气指标、肝肾功能和肠黏膜功能，且不增加不良反应发生率，安全可靠。

Effect of Ulinastatin Combined with Noninvasive Mechanical Ventilation on Patients with Severe Acute Pancreatitis and ARDS

ABSTRACT Objective: To investigate the effect of ulinastatin combined with noninvasive mechanical ventilation on blood gas index, liver and kidney function and intestinal mucosa function in patients with severe acute pancreatitis (SAP) and acute respiratory distress syndrome (ARDS). Methods: A total of 73 SAP patients with ARDS,who were admitted to Qinghai Hospital of T.C.M from January 2015 to January 2020, were selected and were randomly divided into control group (n=36) and study group (n=37). The patients in the control group were treated with noninvasive mechanical ventilation. The patients in the study group were treated with ulinastatin on the basis of the control group''s therapy. The curative effect, blood gas index, liver and kidney function index and intestinal mucus function index of the two groups were compared, and the adverse reactions during the treatment were recorded. Results: After 7 days of treatment,the total clinical effective rate of the study group was 89.19 % (33/37), higher than that66.67 % (24/36)] of the control group (P<0.05); the PaO₂ and oxygenation index of the two groups were higher than those before treatment (P<0.05); AST, alt, bun, Cr, Dao, D-lactate and PaCO₂ in the two groups were lower than those before treatment(P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Ulinastatin combined with noninvasive mechanical ventilation can effectively improve the blood gas index, liver and kidney function and intestinal mucosa function of SAP patients with ARDS, and cannot increase the incidence of adverse reactions, which is safe and reliable.