乌司他丁治疗儿童重型颅脑损伤的疗效及其作用机制

Efficacy of Ulinastatin in Children with Severe Cerebral Trauma and Its Mechanism of Action

目的评价乌司他丁对重型颅脑损伤患儿的疗效并探讨其作用机制。方法对42例外伤后8h入院、昏迷评分≤8分的重型颅脑损伤患儿,按随机数字表法分为观察组和对照组,每组21例。2组均采用常规综合治疗,观察组加用乌司他丁治疗:于入院第1-7天将乌司他丁(1万U.kg-1·d-1)加入生理盐水30mL缓慢静脉滴注,1～2次·d-1。于治疗前及治疗后24h,4、7d分别用ELISA法测定血浆中S-100B蛋白、神经元特异性烯醇酶(NSE)及用特异性放射免疫分析法测定血管内皮素(ET)含量,观察2组患儿的消化道出血率及病死率。结果治疗前2组患儿血浆ET、S-100B蛋白、NSE值均比正常值明显增高,但差异无统计学意义(P>0.05),治疗后24h2组患儿血清ET、S-100B蛋白、NSE水平均有下降,2组差异无统计学意义(P>0.05),治疗后4、7d观察组ET、S-100B蛋白、NSE值明显低于对照组(P<0.01)。观察组病死率、消化道出血率显著低于对照组(P<0.05)。结论乌司他丁可以显著降低重型颅脑损伤ET、S-100B蛋白、NSE的水平,减少消化道出血发生率,降低病死率,改善预后。

Objective To evaluate the efficacy of ulinastatin（UTI） in children with severe cerebral trauma,and to investigate the mechanism of UTI action.Methods Forty-two patients with Glasgow Coma Scale score less than 8 who were admitted to the hospital within 8 hours after severe cerebral trauma were randomly divided into two groups,with 21 patients in each groups.The control group was given conventional therapy.On the basis of conventional therapy,the observation group was additionally treated with intravenous infusion of 10 000 U·kg-1·d-1 UTI dissolved in 30 mL normal saline once-twice per day within the first 1-7 days after admission.Plasma S-100B protein and neuron-specific enolase（NSE） concentrations were measured by ELISA and endothelin（ET） levels were detected by specific radioimmunoassay before and 1,4 and 7 days after treatment.The mortality and digestive bleeding rate were recorded in both groups.Results The ET,NSE and S-100B protein levels in children with severe cerebral trauma were higher than normal values before treatment,but decreased 24 hours after treatment.There were no significant differences between the two groups（P0.05）.Compared with control group,levels of ET,NSE and S-100B protein and rates of mortality and digestive bleeding obviously decreased in observation group 4 and 7 days after treatment（P0.05 or P0.01）.Conclusion UTI can decrease plasma ET,NSE and S-100B protein levels,reduce the mortality and digestive bleeding rates,and improve the prognosis in children with severe cerebral trauma.