乌司他丁联合无创通气治疗急性呼吸窘迫综合征的临床研究

Clinical trial of ulinastatin combined with mechanical ventilation in patients with acute respiratory distress syndrome

目的观察乌司他丁联合无创通气对轻中度急性呼吸窘迫综合征患者的临床疗效与预后。方法 76例轻中度急性呼吸窘迫综合征患者随机分为对照组和试验组,每组38例。对照组用机械通气肺保护策略,试验组在此基础上加用乌司他丁60万U,每天1次。2组均治疗1周。比较2组的临床疗效、住院时间、机械通气时间、急性肺损伤评分,治疗前后炎症因子水平及血气指标。结果治疗后,试验组总有效率为92.11%(35/38例),明显高于对照组的73.68%(28/38例,P<0.05)。试验组的白细胞介素(IL)-6,IL-1β和肿瘤坏死因子-α(TNF-α)水平分别为(105.54±21.34),(0.54±0.05),(8.25±1.21)ng·L^(-1),明显低于对照组的(182.02±25.87),(2.21±0.57),(15.87±1.87)ng·L^(-1)(P<0.05)。试验组的动脉血氧饱和度为(93.15±12.35)%,动脉二氧化碳分压为(40.25±5.47)mm Hg,动脉血氧分压为(80.13±6.87)mm Hg,血氧分压/吸入气氧浓度为(351.47±25.47),明显高于对照组的(84.22±11.47)%,(34.18±3.87)mm Hg,(68.54±5.57)mm Hg,(261.24±15.47),(P<0.05)。试验组的住院时间和机械通气时间分别为(13.87±3.21),(10.25±2.01)d,明显短于对照组的(18.24±4.35),(14.24±2.54)d(P<0.05)。不良反应主要表现为腹泻、皮疹和恶心呕吐,2组不良反应发生率差异无统计学意义(P>0.05)。结论轻中度急性呼吸窘迫综合征患者用乌司他丁联合无创机械通气治疗,可明显降低患者的IL-6、IL-1β、TNF-α炎症因子水平,改善患者的氧合指标,缩短机械通气时间。

Objective To observe the clinical efficacy and prognosis of ulinastatin combined with mechanical ventilation in patients with acute respiratory distress syndrome（ ADRS）. Methods Seventy- six patients were randomly divided into treatment group and control group,with 38 cases in each group. Control group was treated with mechanical ventilation. Treatment group was given ulinastatin 600,000 U,qd on the basis of control group. The course of treatment was 1 week. The clinical efficacy,hospital stay time,mechanical ventilation,acute lung injury score,and treatment of inflammatory cytokines,blood gas index of the two groups were compared before treatment and after treatment.Results After treatment, total effective rate in treatment group was 92. 11%（ 35 /38）,significantly higher than 73. 68% in control group（ 28 /38,P〈0. 05）. Interleukin（ IL）- 6,IL- 1β,and tumor necrosis factor- α（ TNF- α） in treatment group were（ 105. 54 ± 21. 34）,（ 0. 54 ± 0. 05）,（ 8. 25 ± 1. 21） ng · L^（- 1）,significantly lower than（ 182. 02 ± 25. 87）,（ 2. 21 ± 0. 57）,（ 15. 87 ± 1. 87） ng·L^-1in control group（ P〈0. 05）. In treatment group,arterial oxygen saturation（ SaO_2）（ 93. 15 ± 12. 35） %,partial pressure of carbon dioxide（ PaCO_2）（ 40. 25 ± 5. 47） mm Hg,pressure of arterial oxygen（ PaO_2）（ 80. 13 ± 6. 87） mm Hg and partial pressure of oxygen /fraction of inspiration（ PaO_2/ FiO_2）（ 351. 47 ± 25. 47） were significantly higher than（ 84. 22 ± 11. 47） %,（ 34. 18 ± 3. 87） mm Hg,（ 68. 54 ± 5. 57）mm Hg and（ 261. 24 ± 15. 47） in control group（ P〈0. 05）. Hospitalization time and mechanical ventilation time of treatment group were（ 13. 87 ± 3. 21）,（ 10. 25 ± 2. 01） d, significantly shorter than（ 18. 24 ± 4. 35）,（ 14. 24 ± 2. 54） d in control group（ P〈0. 05）. The main adverse drug reactions manifested as diarrhea,rash,nausea and vomiting, with no significant difference of incidence of adverse reactions in two group（ P〉0. 05）.Conclusion Ulinastatin combined with noninvasive mechanical ventilation in the treatment of ARDS patients,could significantly decrease the levels of IL- 6,IL- 1β and TNF- α,improve patients＇ oxygenation index,and shorten the duration of mechanical ventilation.