乌司他丁对危重患者器官功能保护作用的研究

Investigation of ulinastatin on protection of organ functions in patients with severe disease

目的探讨乌司他丁对危重患者器官功能的保护作用及其机制。方法将2005年10月-2007年7月入住本院重症加强治疗病房(ICU)的60例危重患者随机分为治疗组(30例)和对照组(30例)。对照组接受常规治疗;治疗组在常规治疗基础上加用乌司他丁,依病情每次静脉给予200～400 kU,每日2～4次,疗程5～7 d。均于两组患者入ICU即刻及3、5和7 d清晨抽取肘静脉血检测丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐(Cr)、尿素氮(BUN)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及氧合指数(PaO_2/ FiO_2),并记录是否使用呼吸机辅助呼吸、是否进行血液透析治疗以及终点结果。结果治疗组呼吸机使用率(23.3%)、肝功能障碍率(3.3%)、肾功能异常率(10.0%)及病死率(3.3%)均明显低于对照组(分别为63.3%、23.3%、46.7%、10.0%,P<0.05或P<0.01)。治疗组上述各指标的改善程度也明显好于对照组,其中5d和7d时AST、BUN、Cr及PaO_2/FiO_2差异有统计学意义(P<0.05或P<0.01),而ALT、APTT、FIB则差异无统计学意义(P均>0.05)。仅对照组有1例进行血液透析。结论乌司他丁对危重患者肝、肾、肺功能有明显保护作用,能降低危重患者多器官功能障碍综合征(MODS)的发生率及病死率。

Objective To study the mechanism and protection of ulinastatin on organ functions in patients with severe disease. Methods Sixty patients in the intensive care unit （ICU） from October 2005 to July 2007 were randomly divided into a control group and an ulinastatin treatment group （each 30 cases）. The patients in the control group received the conventional therapy, and the cases in the other treatment group accepted ulinastatin and conventional therapy. According to the disease situations, ulinastatin was administered 200 - 400 kU once, 2 - 4 times a day, sequentially for 5 - 7 days. On the day of admission and 3, 5, and 7 days after admission in ICU respectively, blood samples were obtained for measuring alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, ereatinine （Cr）, blood urea nitrogen （BUN）, activated partial thromboplastin time （APTT）, fibrinogen （FIB） and oxygenation index （PaO2/FiO2） ; whether breathing machine or hematodialysis was used and the end results were recorded. Results The rate of usage of breathing machine （23.3 %）, the incidences of hepatosis （3.3 %） and renal dysfunction （10. 0% ） and fatality （3.3%） in ulinastatin treatment group were obviously lower than those of the control group （63.3%, 23.3%, 46.7%, 10. 0%, P〈0. 05 or P〈0. 01）. Amelioration level of each index in the ulinastatin treatment group was better than that of the control group, at the time points of 5th and 7th day, there were statistical significant differences between the two groups in AST, BUN, Cr and PaO2/FiO2 （P〈0. 05 or P〈0.01）, however, there were no noticeable differences in ALT, APTT, FIB （all P〉0. 05）. Only one patient received hematodialysis in control group. Conclusion Ulinastatin can protect liver, renal and lung functions markedly and lower the incidence of multiple organ dysfunction syndrome and mortality in patients with severe disease.