乌司他丁对严重烧伤患者伤后早期心肌损害的防治作用

Effect of Ulinastatin on the management of early myocardiac injury after severe burns

目的观察乌司他丁(UTI)对烧伤“休克心”的防治作用,探讨其可能的机制。方法选择笔者单位收治的伤后24h内人院、烧伤面积＞50%TBSA的34例特重度烧伤患者,分为烧伤组和UTI治疗组,每组17例。两组患者均进行常规治疗,且UTI治疗组患者入院后立即给予UTI 10万U静脉滴注,3次/d,连续7d。于两组患者伤后2、4、7d采血,检测其血浆中性粒细胞弹性蛋白酶(PMN elastase)、心肌肌钙蛋白I(cTnI)含量和心肌型肌酸激酶同工酶(CK-MB)活性,以公认的各指标正常值作参考,并对3项指标进行相关性分析。结果(1)伤后2、4、7d,两组患者血浆PMN elastase及cTnI含量均显著高于正常值(P＜0．01)；UTI治疗组与烧伤组比较,两指标偏低。(2)与正常值比较,伤后2、4、7d烧伤组患者CK-MB活性明显升高(P＜0．01),第4天达高峰；UTI治疗组伤后2、4d CK-MB活性明显高于正常值(P＜0．05或0．01),但与烧伤组比较升幅较小,第7天降至正常值水平(P＞0．05)。(3)34例烧伤患者PMN elastase、cTnI含量及CK-MB活性三者间均呈现显著正相关,前两者的相关系数为0．904,后两者的相关系数为0．922,PMN elastase含量与CK-MB活性的相关系数为0．829(均为P＜0．01)。结论UTI能够显著减轻严重烧伤患者心肌损害的程度,有效抑制PMN elastase的过度释放。

Objective To investigate the effect of Ulinastatin on the management of early myocardial injury and its mechanisms. Methods Thirty-four severe burn patients with TBSA exceeding 50% were admitted into our hospital within 24hrs after burns, and they were divided into burn group（ n = 17） and ulinastatin-treated group （ n = 17, UTI group）. All patients received conventional treatment. The patients in UTI group were given 100,000 U ulinastatin intravenously immediately after admission, 3 times a day for a week. The plasma content of troponin I（cTnI） , creatine kinase （CK-MB） and PMN elastase were determined on 2, 4 and 7 postburn days（PBD） , and the correlate relationship among these three indices were analyzed. Results （ 1 ） The plasma content of cTnI and PMN elastase at 2, 4, 7 PBDs were significantly higher than that of normal value （ P 〈 0.01 ） , but they were obviously lower in UTI group than that in burn group . （2） Compared with normal value, the plasma content of CK-MB in burn group was increased significantly on 2, 4 and7 PBDs （ P 〈0.01）, and it reached the peak on 4 PBD. Though it was obviously higher in UTS group on 2 and 4 PBDs compared with the normal value, but it was lower than that in .burn group （ P 〈 0.05 or 0.01 ） , and it returned to normal value on 7 PBD. （3） There exhibited positive correlation among the PMN elastase content, cTnI content and CK-MB activity of the 34 patients. The correlation index of PMN elastase content and cTnI content was 0. 904, while that between cTnI content and CK-MB activity was 0. 922, and that between PMN elastase content and CK-MB activity was 0. 829（ P 〈 0.01 ）. Conclusion Ulinastatin is beneficial in alleviating myocardial injury after severe burns, and it reduces the release of PMN elastase.