肺保护性通气联合乌司他丁对开腹术后危重症患者肺保护作用的临床观察

Clinical observation of the lung protective effects in severe postoperative critical patients who were treated with lung protective ventilation and ulinastatin

目的观察肺保护性通气联合乌司他丁对开腹手术后危重症患者的肺保护作用。方法 2010年6月—2014年8月河北医科大学第三医院ICU收治开腹手术后危重症患者60例,随机数字表法分为对照组和观察组,每组30例。对照组仅以肺保护通气疗法为主,观察组为肺保护通气疗法联合乌司他丁干预治疗(2 h内静脉滴注乌司他丁30万U+生理盐水250 ml,1次/d,疗程5 d)。术后5 d内观察患者的生命体征,记录术后第1天和第5天呼吸力学相关指标、动脉血气、心肺肝肾等重要脏器功能及患者预后、相关并发症和病死率。结果术后第5天,观察组心率(HR)慢于对照组,平均动脉压(MAP)、呼吸系统顺应性(Crs),pH、PaO_2、PaO_2/FiO_2高于对照组(P<0.05),吸气峰压(PIP)、气道阻力(Raw)、平均气道压(MPaw)低于对照组(P<0.05);肺损伤得到控制及肺外器官功能改善率明显高于对照组(40.0%vs.66.7%,P<0.05);机械通气致肺损伤发生率、心律失常和心肌缺缸发生率、死于顽固性低氧血症、ICU病死率均明显低于对照组(20.0%vs.3.3%,33.3%vs.10.0%,20.0%vs.3.3%,6.7%vs.3.3%,26.7%vs.6.7%,P<0.05)。结论肺保护性通气联合乌司他丁干预能改善开腹手术后危重症患者的呼吸力学与氧合功能,血流动力学更平稳,能降低呼吸机相关并发症和术后肺部并发症的发生率。

Objective To observe the lung protective effects of the lung protective ventilation and ulinaslalinin for severe patients after abdominal region surgery.Methods Sixty patients were selected from June 2010 to August 2014,who were received treatment after laparotomy in icu of the third affiliated hospital of Hehei Medical University,randomly divided into the control group and the observation group,30 cases in each group.Patients in the control group were treated only with lung protective ventilation,while patients in the observation group with lung protective ventilation and ulinaslatin（ulinastatin 300 thousand units with 250 ml saline were intravenous injected in two hours,one time per day,5 days of a course）.Patient＇s vital signs were observed within 5 d,and the pneumodynamics index,arterial blood gas analysis,biochemical examination of vital organs as heart,lung,liver and kidney etc were recorded in the first and fifth day.The prognosis,complications and mortality of patients were also observed.Results Compared to the contorl group,HH,PIP,Raw,MPaw were lower in the observation group,the MAP,Crs,pH,PaO_2 PaO_2/FiO_2 were higher those in the observation group（P〈0.05）.The improvement rate ol lung injury under control and extra-pulmonary organs were significantly higher than those in the control group（40.0%vs.66.7%,P〈0.05）.The incidence rates of ventilator induced lung injury,arrhythmia and myocardial ischemia,rale of died of refractory hypoxemia and ICU mortality rale were significantly lower in the control group（20.0%vs.3.3%.33.3%vs.10.0%,20.0%vs.3.3%,6.7%vs.3.3%,26.7%vs.6.7%,P〈0.05）.Conclusion lt demonstrated that the ulinastatin intervention in lung protective ventilation could improve the pneumodynamics,pulmonary function,hemodynmnics of severe patients after abdominal region surgery,it could reduce the incidence of ventilator associated complications and postoperative pulmonary complications.