持续性血液净化联合乌司他丁治疗ARDS的临床研究

目的：研究连续性血液净化联合乌司他丁治疗急性呼吸窘迫综合症（ARDS）患者的临床疗效。方法：将2011年5月至2012年12月收治的40例ARDS患者随机分为对照组（n=20例）和观察组（n=20例），其中对照组采用常规治疗方案十连续性血液净化，观察组在对照组基础上加用乌司他丁治疗。观察比较患者治疗效果，分别于治疗前后测定动脉血气分析，计算氧合指数；ELISA法检测血清IL-6及TNF-α水平；进行急性生理和慢性健康状态APACHEII评分；统计机械通气时间及住ICU时间。结果：①与对照组相比，观察组患者氧合指数明显升高（P〈0．05）。②与对照组相比，观察组IL-6及TNF-α明显下降，差异有统计学意义（P〈0．05）。⑨治疗后，APACHEII评分明显下降，差异有统计学意义（P〈0．05）。④观察组机械通气时间及住ICU时间较对照组缩短，差异有统计学意义（P〈0．05）。结论：连续性血液净化联合乌司他丁可有效改善氧合，抑制ARDS患者炎症反应，改善患者预后。

Clinical Study on the Treatment of Continuous Blood Purification Combined with Ulinastatin for Patients with ARDS＊

Objective： To investigate the effect of continuous blood purification combined Ulinastatin on inflammation of patients with ARDS, as well as the clinical outcomes. Methods： 40 patients suffered from ARDS in our department from May 2011 to December 2012 randomly divided into control group （n=20）, and observation group （n=20）. The control group received classical treatment and con- tinuous blood purification, and the observation group was added with Ulinastatin. The therapeutic efficacy was observed, the blood gas analysis was evaluated before and after treatment and the oxygenation index was obtained; ELISA was used to quantify the serum concentration of IL-6 and TNF-α. The APACHE II score, duration of mechanical ventilation and ICU stay were observed. Results： （1） Com- pared with control, the oxygenation index increased in observation group （P〈0.05）. （2） Compared with control, the serum concentration of IL-6 and TNF-α decreased obviously （P〈0.05）. （3） After treatment, the APACHE n score of observation group was significantly lower than control group （P〈0.05）. （4） Compared with control, the duration of mechanical ventilation and length of ICU stay significantly de- creased in observation group （P〈0.05）. Conclusion： Combination of continuous blood purification and Ulinastatin for the treatment of ARDS can increase oxygenation index, inhibit inflammatory response, and improve prognosis.