乌司他丁保护心肺复苏术后脏器生理功能的最佳剂量临床研究

Clinical effect of different ulinastatin dose on organ physiological function after cardiopulmonary resuscitation

目的探讨不同剂量乌司他丁对心肺复苏术后脏器生理功能的临床效果。方法选取行心肺复苏术的患者80例,根据乌司他丁的剂量将其分为高剂量组和低剂量组,每组各40例。高剂量组应用100万U/d的乌司他丁,低剂量组应用20万U/d的乌司他丁。检测并对比两组患者ROSC(自主循环恢复)后即刻、24h、48h、72h的CK-MB(肌酸激酶同工酶)、HDBH(α-羟丁酸脱氢酶)、m-AST(谷草转氨酶同工酶)等心肌酶学指标及AST(谷草转氨酶)、ALT(谷丙转氨酶)等肝功能指标及BUN(尿素氮)、Cr(肌酐)等肾功能指标,对比两组患者治疗后PR-MODS(复苏后器官功能障碍综合征)发生率和28d存活率。结果两组患者ROSC后即刻的各项心肌酶指标、肝功能指标、肾功能指标均无统计学意义差异(P>0.05),ROSC后24h、48h、72h各项指标均先升高再下降,且高剂量组的各项指标均优于低剂量组(P<0.05)。高剂量组治疗后PR-MODS发生率显著低于低剂量组(χ~2=4.114,P<0.01);高剂量组治疗后28d存活率显著高于低剂量组(χ~2=4.073,P<0.01)。结论高剂量乌司他丁可有效保护心肺复苏术后脏器生理功能,降低PR-MODS的发生率,提高存活率。

Objective To investigate the clinical effect of different dose ulinastatin on organ physiological function after cardiopulmonary resuscitation. Methods A total of 80 patients undergoing cardiopulmonary resuscitation were randomly divided into the high dose group and the low dose group, 40 cases in each group. The high dose group was given 1000000 U/d dose of ulinastatin, and the low dose group with a dose of 200000 U/d. The cardiac function like CK-MB （creatine kinase isoenzyme）, HDBH （alpha hydroxybutyrate dehydrogenase）, m-AST （aspartate aminotransferase isoenzymes）, liver function like AST （ aspartate aminotransferase）, ALT （ alanine aminotransferase） and other liver function indexes, renal function like BUN （ Urea nitrogen）, Cr （creatinine） were compared between the two group at ROSC （ spontaneous circulation after recovery） immediately, 24h, 48h and 72h. The PR- MODS （recovery after organ dysfunction integrated syndrome） incidence and 28d survival rate were also compared. Results At ROSC, there was no significant difference in myoeardium enzyme, liver function and renal function indexes between the two groups （ P 〉 0.05 ）. 24h, 48h and 72h after ROSC, those indexes increased first and then decreased and the indicators in the high dose group were better than those in the low dose group （ P 〈 0. 05 ）. The incidence of PR-MODS in the high dose group was significantly lower than that in the low dose group （ X2 = 4. 114,P 〈0. 01 ）, and the survival rate of 28d was significantly higher than that of the low dose group （ X2 = 4. 073, P 〈 0.01 ）. Conclusion High dose of ulinastatin can effectively protect cardiopulmonary resuscitation after organ physiological function and reduce the incidence of PR-MODS and improve the survival rate.