乌司他丁与沐舒坦治疗严重烧伤伴吸入性损伤的疗效分析

Efficacy of High-dose Ulinastatin and Ambroxol Using for Early Combination of Severe Burns with Severe Inhalation Injury

目的：探讨严重烧伤伴中重度吸入性损伤患者早期联合使用大剂量乌司他丁与沐舒坦的临床疗效。方法：选择2003年5月-2013年5月在我院接受治疗的185例严重烧伤伴中重度吸入性损伤患者，随机分为两组，治疗组93例，对照组92例。两组患者在确诊为中重度吸入性损伤后，立即给予传统常规治疗：吸氧、视情尽早预防性气管切开、湿化气道及气道灌洗、翻身拍背吸痰、呼吸机辅助呼吸等。治疗组在常规治疗的基础上给予乌司他丁40万单位，每隔8h静脉滴注，沐舒坦450mg，每隔12h微泵静推；对照组给予乌司他丁10万单位，每隔8h静滴，沐舒坦30mg，每隔8h静滴，疗程为10天，比较两组患者急性肺损伤（Au）的发生率、急性呼吸窘迫综合征（ARDS）的发生率、呼吸机使用时间、死亡率。结果：治疗组93例患者，治愈92例，死亡1例，死亡率为1．08％（1／93），治疗过程中发生AL134例，ARDS12例，呼吸机使用时间为（4．2±2．1）d。对照组92例患者治愈88例，死亡4例，死亡率率为4．35％（4／92），治疗过程中发生AL143例，ARDS17例，呼吸机使用时间为（8．2±2．7）d。两组患者ALI发生率、ARDS发生率、呼吸机使用时间、治愈率差异均有统计学意义（P〈0．05）。结论：对于严重烧伤伴中重度吸入性损伤的患者，在气管切开的前提下，给予常规传统治疗的同时，采用大剂量乌司他丁与沐舒坦早期联合使用给药，能够明显的提高治愈率，降低并发症，值得在临床上广泛推广应用。

Objective： To investigate the clinical efficacy of large doses Ulinastatin with ambroxol using for severe burns with se- vere inhalation injury in patients with early joint. Methods： 185 cases of severe bums with severe inhalation injury from May 2003 to May 2013 treated in our hospital were selected and randomly divided into two groups, the treatment group with 93 cases, 92 cases of the control group. Both groups were diagnosed with moderate to severe inhalation injury, immediately given the traditional conventional treatment： oxygen, depending on the situation as soon as possible preventive tracheotomy airway humidification and airway lavage, stand back suction, ventilator-assisted breathing. Treatment group was given Ulinastatin 400,000 units every 8h intravenously Ambroxol 450mg, every 12h micropump bolus on the basis of the conventional treatment; control group were given ulinastatin 100,000 units every 8h infusion, ambroxo130mg, every 8h intravenously, treatment for 10 days. Acute lung injury（ALI） the incidence of acute respiratory dis- tress syndrome （ARDS） the incidence ofventilator use oftime, death rate were compared between the two groups of patients with. Results： The treatment group, 93 patients were cured 92 cases, 1 patient died, the mortality rate was 1.08% （1/93）, the course of treatment ALI34 cases, ARDS12 cases, mechanical ventilation time was （4.2 ± 2.1） d. Control group, 92 patients were cured 88 cases, 4 deaths, the mor- tality rate was 4.35% （4/92）, the course of treatment ALI43 cases, ARDS17 cases, mechanical ventilation time was （8.2 ± 2.7） d. Two groups of patients the incidence of ALI, ARDS incidence of ventilator use of time, the cure rate differences were statistically significant （P 〈0.05）. Conclusion： For severe bums with severe inhalation injury patients, tracheotomy premise, given conventional treatment, giving high-dose ulinastatin conjunction with ambroxol early could significantly improve the cure rate, reduce complications, so it was worth widely used in clinical application.