靶器官保护策略对急性肺损伤的防护作用

Target organ protection strategy in acute lung injury

目的探讨靶器官保护策略对急性肺损伤的防护作用。方法将急性肺损伤患者85例完全随机分为对照组（42例）和研究组（43例）。2组给予常规治疗，研究组为保护炎症靶器官（肠道、肺脏）加用①生大黄30g，水煎成200ml溶液（水煎15min），分2次／d口服或管饲；②静脉滴注盐酸氨溴索60mg，2次／d；③静脉注射乌司他丁40万U，1次／8h，疗程7d。监测患者治疗前后呼吸频率、PaO2、氧合指数、血清中肿瘤坏死因子-α（TNF-α）、白细胞介素6（IL-6）、IL一8水平、7d后全身炎症反应综合征（SIRS）评分及预后情况。结果2组治疗前各项监测指标差异无统计学意义，治疗后研究组患者呼吸频率、PaO，、氧合指数、SIRS评分明显优于对照组（P〈0．05）；研究组TNF一仅、IL-6、IL一8于治疗第3天明显下降，改善均优于对照组（P〈0．05）。研究组7d后SIRS评分低于对照组，但差异无统计学意义[（1．7±1．3）分比（2．64-1．3）分，P〉0．05]；ARDS发生率低于对照组[29．2％（12／43）比59．5％（25／42），P〈0．05]；病死率虽低于对照组，但差异无统计学意义[18．6％（8／43）比25．6％（11／42），P〉0．05]。结论注重炎症靶器官保护可抑制炎症介质产生、释放和体内炎症反应的放大，提供肺保护作用。

Objective To investigate the preventive and protective effect of target organ protection strategy on acute lung injury. Methods Eighty-five acute lung injury patients were randomly divided into two groups; con- tro] group （ n = 42） was treated commonly and research group （ n = 43 ） was treated with target organ protected treatment protocols besides the conventional therapy for 7 days. Respiratory rate, oxygenation index, systemic inflammatory response syndrome （SIRS） scores, tumor necrosis factor α （TNF-α） , interleukin 6 （IL-6） and IL-8 were ana- lyzed. Results The differences between two groups were not statistically significant before treatment （ P 〉 0.05 ）. The contrast of respiratory rate, oxygenation index, PaO2 and SIRS scores between two groups were statistically sig- nificant （ P 〈 0.05 ） ; the contrast of TNF-α, IL-6, IL-8 between two groups were statistically significant （ P 〈 0. 05）after treatment. The incidence of acute respiratory distress syndrome （ARDS） of experimental group reduced relatively [29.2% （ 12/43 ） vs 59.5% （25/42）, P 〈 0.05 ] ; the mortality between two groups was not statistically significant [ 18.6% （ 8/43 ） vs 25.6% （ 11/42 ）, P 〉 0.05 ]. Conclusions Emphasizing protecting inflammatory target organ can restrain inflammatory mediators creation and releasing, interrupt the amplification of inflammatory response and protect the pulmonary function.