依达拉奉联合乌司他丁对创伤性湿肺患者氧代谢、炎性反应及氧化应激的影响

Effects of edaravone combined with ulinastatin on oxygen metabolism,inflammatory response and oxidative stress in patients with traumatic wet lung

目的观察依达拉奉联合乌司他丁对创伤性湿肺患者氧代谢、炎性反应及氧化应激的影响。方法 100例创伤性湿肺患者随机分为对照组和观察组,每组50例。对照组在基础治疗和呼吸支持的基础上加用乌司他丁(30万U,静脉滴注, bid),观察组在对照组治疗的基础上加用依达拉奉(30 mg,静脉滴注,bid),连用14 d。比较两组患者治疗前后急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、氧代谢指标[呼吸频率(RR)、动脉血氧分压(PaO_2)、氧合指数(PaO_2/FiO_2)、动脉血氧饱和度(SaO_2)和血乳酸(Lac)]、炎性因子[C反应蛋白(CRP)、白细胞介素-6 (IL-6)、肿瘤坏死因子-α(TNF-α)]及氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、表面活性物质相关蛋白D (SP-D)]的变化,记录两组患者药物不良反应、病情演变及预后状况。结果治疗14 d后,两组患者的APACHEⅡ评分及氧代谢指标(RR、 PaO_2、 PaO_2/FiO_2、 SaO_2、 Lac)、炎性因子(CRP、 IL-6、 TNF-α)水平、氧化应激指标(MDA、 SP-D)均较治疗前明显改善(均P <0.01),而观察组患者改善更显著(P <0.01)。两组SOD水平均有下降,但观察组SOD水平显著高于对照组(P <0.01)。观察组患者的肺挫伤程度、脱机时间、 ICU住院时间及肺实变率均优于对照组(P <0.01或P <0.05)。两组患者的药物不良反应发生率差异无显著意义(P> 0.05)。结论依达拉奉联合乌司他丁治疗创伤性湿肺,可有效改善患者氧代谢、炎性反应和氧化应激水平,疗效优于乌司他丁单用,安全性好。

AIM To observe the effects of edaravone combined with ulinastatin on oxygen metabolism, inflammatory response and oxidative stress in patients with traumatic wet lung (TWL).METHODS One hundred patients with TWL were randomly divided into control group (n =50)and observation group (n =50). The control group was given ulinastatin (300000 U,intravenous drip,bid)on the basis of basic treatment and respiratory support,and the observation group was treated with edaravone (30 mg,intravenous drip,bid)on the basis of the treatment in the control group,continuous use for 14 days.Changes of acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score,oxygen metabolism index (respiratory rate (RR),arterial partial pressure of oxygen (PaO2),oxygen index (PaO2/FiO2),arterial oxygen saturation (SaO2)and blood lactic acid (Lac)),inflammation index (C-reactive protein (CRP),interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α)),and oxidative stress index (malondialdehyde (MDA),superoxide dismutase (SOD), surface active substance associated protein (SP-D))levels of patients in two groups were eompared before and after treatment.The adverse drug reactions,disease progression and prognosis of two groups were recorded. RESULTS Compared with those before the treatment,APACHE Ⅱ score,and the oxygen metabolism index (RR,PaO2,PaO2/FiO2,SaO2,Lac),inflammation index (CRP,IL-6,TNF-α),oxidative stress index (MDA,SP-D)improved significantly after 14 days of treatment (all P <0.01)in two groups,and those in the observation group improved more significantly (P <0.01).The levels of SOD decreased in two groups,but the SOD level in the observation group was significantly higher than that in the control group (P <0.01).The degree of pulmonary contusion,off -line time,ICU hospitalization time and lung consolidation rate in the observation group were better than those in the control group (P <0.01 or P <0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups (P >0.05).CONCLUSION Edaravone combined with ulinastatin in treating TWL can improve the levels of oxygen metabolism,inflammation response and oxidative stress,has better curative effect compared with ulinastatin alone and has good safe.