严重脓毒症性急性呼吸窘迫综合征血管外肺水的变化以及乌司他丁的作用分析

Changes of extra-vascular lung water in severe sepsis with acute respiratory distress syndrome and the effect of ulinastatin

目的探讨严重脓毒症性急性呼吸窘迫综合征(ARDS)血管外肺水的变化,并分析乌司他丁的治疗效果。方法选择严重脓毒症性ARDS患者80例,随机分为观察组与对照组各40例,其中对照组患者给予常规治疗,观察组在常规治疗的基础上给予乌司他丁治疗,观察两组患者血管外肺水(EVLW)、呼吸功能、APACHE-Ⅱ评分、炎症因子变化。结果 (1)两组患者EVLW水平高于正常基值7m L/Kg,治疗第3d EVLW优于第1d,治疗第7d、12d PaO_2、PaO_2/FiO_2、APACHE-Ⅱ评分优于第1d、3d,差异具有统计学意义(P<0.05),观察组较对照组EVLW、PaO_2、PaO_2/FiO_2、APACHE-Ⅱ评分改善显著,差异有统计学意义(P<0.05);(2)观察组治疗3d、7d血清TNF-α、IL-6、CRP水平增高低于对照组,12d下降较对照组显著,比较差异均有统计学意义(P<0.05)。结论严重脓毒症性ARDS血管外肺水显著增高,有效治疗后减低,乌司他丁有助于早期改善肺功能及炎性因子水平。

Objective To investigate the changes of extra-vascular lung water in severe sepsis patients with acute respiratory distress syndrome （ARDS）, and to analyze the therapeutic effect of ulinastatin. Methods 80 se- vere sepsis patients with septic ARDS were randomly divided into the observation group and the control group with 50 cases in each group. The control group was given conventional treatment, while the observation group was given ulinastatin on basis of the control group. Their vascular lung water （ EVLW）, respiratory function, APACHE-Ⅱscore, and the changes of inflammatory factors were observed in the two groups. Results （1） EVLW levels of the two groups were higher than 7mL/Kg of normal basic value, the level of EVLW 3 days after treatment was better than ld. The levels of PaO2, PaO2/FiO2 and APACHE-Ⅱ score after 7d and 12d were better than ld and 3d （P 〈 0. 05 ）. The levels of EVLW, PaO2, PaO2/FiO2 and APACHE-Ⅱ score in the observation group were significantly better than those in the control group （P 〈0. 05）. （2） The increase of serum levels of CRP, IL-6 and TNF-α of the observation group after 3d, 7d were significantly lower than the control group after 3d, 7d of treatment, the decrease after 12d was more significant than the control group （P 〈 0. 05）. Conclusion Extra-vascular lung water in severe sepsis pa- tients with acute respiratory distress syndrome is increased significantly, which is decreased after effective treatment, and ulinastatin can help improve on early pulmonary function and inflammatory factor levels.