乌司他丁和糖皮质激素在慢性阻塞性肺疾病并呼吸衰竭中的对比研究

Ulinastatin versus glueocorticoids in the treatment of COPD with acute respiratory failure

目的比较乌司他丁和糖皮质激素在慢性阻塞性肺疾病（COPD）并呼吸衰竭中的应用。方法将68例COPD并呼吸衰竭患者随机分为乌司他丁治疗组和糖皮质激素治疗组，分析并比较两组不同治疗方法对呼吸力学的影响，以及并发症的发生率和转归。结果乌司他丁治疗组治疗前峰压（32．0±6．4）cmH2O、平台压（27．0±7．2）cmH2O，治疗的第48小时峰压（29．0±5．6）cmH2O、平台压（24．0±4．9）cmH2O，治疗的第72小时峰压（25．0±6．6）cmH2O、平台压（21．0±6．7）cmH：O；糖皮质激素治疗组治疗前峰压（33．0±5．8）cmHz0、平台压（28．0±6．3）cmH2O，治疗的第48小时峰压（26．0±6．7）cmH2O、平台压（22．0±3．1）cmH2O，治疗的第72小时峰压（24．0±5．8）cmH2O、平台压（20．0±6．2）cmH2O。结论乌司他丁治疗COPD并呼吸衰竭患者疗效肯定，并发症少，可望代替糖皮质激素应用于COPD并呼吸衰竭的临床救治。

Objective To eompare the efficacy of ulinastatin versus that of glucocorticoids for chronic obstruetive pulmonary disease （COPD） with acute respiratory failure. Methods 68 patients with COPD and acute respiratory failure were randomly divided into ulinastatin group and glucoeorticoids group. The effeet of these two different therapies on respiratory mechanics was compared. The outcomes and the incidence ratio of complications were analyzed.Results The airway peak pressure and the plateau pressure were obviously reduced, especially in glucucorticoids group, and the difference was significant on day 2 as compared with ulinastatin group; but they did not differ significantly on day 3. There were no significant differences in the success rate of ventilator removal （in 10 days）, the incidence of hyperglycemia, and the mortality rate. The incidences of upper gastrointestinal bleeding and worsened infectiun were hgiher in glucocorticoids group than in ulinastatin group.Conclusions Ulinastatin is effective in the treatment of COPD with acute respiratory failure and has fewer complications.