早期大剂量乌司他丁治疗急性肺挫伤的疗效观察

目的：探讨早期大剂量乌司他丁治疗急性肺挫伤的临床疗效。方法：选择102例在湖南中医药大学第一附属医院胸外科治疗的急性肺挫伤患者，随机分为A组（对照组）、B组（常规剂量组）和C组（大剂量组），每组各34例。A组患者给予常规治疗；B组在对照组治疗基础上给予乌司他丁10万单位加入0．9％氯化钠100mL静脉滴注，每8h1次，连用7d；C组在对照组治疗基础上给予乌司他丁40万单位加入0．9％氯化钠100mL静脉滴注，每8h1次，连用7d。分别测定和比较3组患者在治疗前、治疗第1天、治疗第4天、治疗第7天的动脉血氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、氧合指数（PaO2／FiO2、血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）的水平以及治疗期间3组患者急性呼吸窘迫综合征（ARDS）T2．肺部感染的发生率。结果：治疗后，B组的PaO2水平在第7天较A组升高，C组的PaO2水平在第1、4、7天较A组均有升高，在第1、4天较B组亦有升高（P〈0．05）；B、C两组PaCO：水平在第4天较A组均有升高（P〈0．05）；B组的PaO2／FiO2水平在第7天较A组升高，C组的PaO/FiO2水平在第4、7天较A、B两组均有升高（P〈0.05）。B组的TNF—α水平在第7天较A组降低，C组的TNF-α水平在第4、7天较A组降低，在第4天较B组降低（P〈0．05）；B组的IL-6水平在第7天较A组降低，C组的IL-6水平在第4、7天较A、B组均降低（P〈0．05）。各组ARDS及肺部感染的发生率比较无统计学差异（P〉0．05）。结论：早期大剂量乌司他丁对急性肺挫伤具有明显的临床疗效。

Observation on the Clinical Efficacy of Early Therapeutic with High Dose Ulinastatin in the Treatment of Acute Pulmonary Contusion

Objective： To investigate the clinical efficacy of early therapeutic with high dose ulinastatin in the treatment of acute pulmonary contusion. Methods： A total of 102 patients with pulmonary contusion were randomly divided into Group A （n=34, control group）, Group B （n=34, regular dose group） and Group C （n=34, high dose group）. The patients of Group A received routine treatment, while the patients of Group B were given Ulinastatin（100 kU intravenous drip once every 8 hours and continued 7 days） in addition, and the patients of Group C also were given Ulinastatin （400 kU intravenous drip once every 8 hours and continued 7 days） in addition. Artery oxygen pressure （PaO2）, carbon dioxide pressure （PaCO2）, oxygenation index （PaO2/FiO2）, serum tumor necmsis factor alpha （TNF-a） and interleukin 6（IL-6） levels were measured on the 1 st, 4th and 7th day in these groups. The incidence rates of acute respiratory distress syndrome （ARDS） and pulmonary infection were compared among three groups during the treatment. Results： After treatment, PaO2 in group B was higher than that in group A on 7th day （P〈0.05）, PaO2 in group C was higher than that in group A on 1st, 4th and 7th day （P〈0.05）, PaO2 in group C was higher than that in group B on 1st and 4th day （P〈0.05）; PaCOz in group B and C were higher than that in group A on 4th day（P〈0.05）; PaO2/FiO2 in group B was higher than that in group A on 7th day （P〈0.05）, PaOJFiO2 in group C were higher than those in group A and B on 4th and 7th day （P〈0.05）; TNF-a in group B was lower than that in group A on 7th day （P〈0.05）, TNF-a in group C was lower than that in group A on 4th and 7th day （P〈0.05）, TNF-o~ in group C was also lower than that in group B on 4th day （P〈0.05）; IL-6 in group B was lower than that in group A on 7th day（P〈0.05）, IL-6 in group C was lower than those in group A and B on 4th and 7th day （P〈0.05）. No significant difference was observed in the incidence rates of ARDS and pulmonary in- fection among three groups during the treatment. Conclusions： Early high-dose application of ulinastatin was obviously effective in the treatment of acute pulmonary contusion.