乌司他丁对急性肺损伤/急性呼吸窘迫综合征的治疗研究

目的研究大剂量乌司他丁在急性肺损伤/急性呼吸窘迫综合征中的治疗效果。方法回顾性分析2006年1月至2010年1月广西医科大学第一附属医院ICU收治的154例ALI/ARDS患者的临床资料,根据治疗方案分为乌司他丁组(UTI组)(n=80),对照组(n=74)。记录两组患者开始治疗、治疗第3天、治疗第7天的生命体征、动脉血气分析、血生化检查结果;记录患者在ICU治疗的转归。应用SPSS 13.0软件对结果进行统计学分析。结果经治疗3天UTI组呼吸频率低于对照组;动脉血气分析提示两组患者PaO2、PaO2/Fi O2、SaO2均有上升,UTI组PaO2/Fi O2略低于对照组(P0.01),而两组患者PaO2、SaO2比较无统计学差异。UTI组与对照组的死亡率比较(UTI组52.5%,对照组52.7%,P=0.980)无统计学差异,机械通气时间UTI组低于对照组UTI组(14.8±3.9)天,对照组(16.7±4.2)天,P=0.020]。根据ALI/ARDS发生的病因分为肺内源性及肺外源性进行亚组分析(A组:肺内源性ALI/ARDS,使用UTI治疗;B组:肺内源性ALI/ARDS,不使用UTI治疗;C组:肺外源性ALI/ARDS,使用UTI治疗;D组:肺外源性ALI/ARDS,不使用UTI治疗),发现乌司他丁对肺外源性ALI/ARDS患者(C组)的ICU时间、ICU内死亡率及机械通气时间均低于不使用UTI的患者(D组)。结论大剂量乌司他丁用于ALI/ARDS的临床治疗可有效改善患者氧合指数,减少机械通气时间,且高血糖的发生率低,尤其是乌司他丁治疗肺外源性ALI/ARDS患者的预后优于肺内源性的ALI/ARDS。

Effects of ulinastatin treatment on the acute lung injury/acute respiratory distress syndrome

Objective To investigate high-dose ulinastatin＇s treatment effect on acute lung injury/acute respiratory distress syndrome.Methods Retrospective analysis were taken on 154 cases of ALI/ARDS patients admitted to ICU of the First Affiliated Hospital of Guangxi Medical University from January 2006 to January 2010.Put the cases into ulinastatin group（n=80）,or the control group（n=74） depending on whether using ulinastatin or not.Recorded the patients＇ vital signs,arterial blood gas analysis,blood biochemistry test results and outcomes respectively on starting treatment,treatment for 3 days,and 7 days.SPSS 13.0 software was applicate for statistical analysis of the results.Results In UTI group the respiratory rate was less than the control group after treatment 3 d;arterial blood gas analysis showed that all the patients＇ PaO2,PaO2/FiO2,SaO2 were increased,PaO2/FiO2 of UTI group was lower than the control group（P0.01）,PaO2,SaO2 was no significant difference between UTI group and control group.UTI treatment group and control group had no significant difference in mortality rate（UTI group 52.5% vs.The control group 52.7%,P=0.980）.The UTI group＇s duration of mechanical ventilation UTI group（14.8±3.9）d vs.The control group（16.7±4.2）d,P=0.020] were less than the control group.Subgroup analysis were taken according to ALI/ARDS occurred caused by extrapulmonary disease or origin in pulmonary disease（A group： lung-derived ALI/ARDS,using the UTI treatment;B group：lung-derived ALI/ARDS,no Use UTI treatment;C group：Exogenous pulmonary ALI/ARDS,using the UTI treatment;D group：Exogenous pulmonary ALI/ARDS,do not use the UTI treatment）.Ulinastatin for exogenous pulmonary ALI/ARDS patients（C） had better outcomes of the ICU time,ICU mortality and mechanical ventilation in patients with UTI than non-use（D group）.Conclusion High-dose ulinastatin for ALI/ARDS may improve the clinical treatment effect of oxygenation index,reduce the duration of mechanical ventilation,and have low incidence of high blood sugar.Especially in treatment of extrapulmonary disease ALI/ARDS patients,the prognosis is better than lung-derived ALI/ARDS.