乌司他汀辅助对呼吸机相关性肺炎患者疗效的影响及机制

Effect and mechanism of ulinastatin on the efficacy of ventilator-associated pneumonia

目的 探讨乌司他汀辅助治疗呼吸机相关性肺炎（VAP）的临床疗效及初步治疗机制。方法 选择2015年1月~2016年2月浙江省庆元县人民医院收治的呼吸机相关性肺炎患者76例,随机数字表法分为对照组和观察组,每组38例。2组均给予机械通气、化痰、抗感染、补液、营养支持等常规治疗,观察组在常规治疗基础上给予乌斯他汀辅助治疗,比较2组治疗效果,同时测定治疗前后血清白介素-6（IL-6）、C-反应蛋白（CRP）、降钙素原（PCT）及肿瘤坏死因子-α（TNF-α）水平变化。结果 观察组治疗总有效率94.74%,显著高于对照组的78.95%,差异有统计学意义（P〈0.05）,2组治疗后血清CRP与PCT水平较治疗前均降低;观察组治疗后血清CRP与PCT水平分别为（45.19±5.79）mg/L与（1.08±0.36）μg/L,显著低于治疗前及对照组治疗后,差异有统计学意义（P〈0.05）,2组治疗后血清IL-6与TNF-α水平较治疗前均降低;观察组治疗后血清IL-6与TNF-α水平分别为（165.29±19.23）pm/m L与（1.16±0.25）pg/m L,显著低于治疗前及对照组治疗后,差异有统计学意义（P〈0.05）。结论 乌司他汀辅助治疗呼吸机相关性肺炎能有效减轻患者体内的炎症反应,减少炎症因子对肺组织损伤,可缓解患者病情进展,有利于改善其预后。

Objective To investigate the effect of ulinastatin in adjuvant treatment of ventilator-associated pneumonia （VAP） and preliminary clinical efficacy of the therapy mechanism. Methods 76 patients with ventilator-associated pneumonia from January 2015 to February 2016 in Qingyuan Peopled Hospital of Zhejiang Province were selected and randomly divided into control group and observation group, 38 cases in each group. Two groups were given mechanical ventilation, phlegm, anti infection, rehydration, nutritional support and other conventional treatment, the observation group on he basis of routine treatment for ulinastatin adjuvant therapy, comparison of two groups of treatment, the simultaneous determination of serum interleukin-6 （IL-6） , C- reactive protein （CRP） and procalcitonin （PCT） and tumor necrosis factor alpha （TNF- alpha） levels were measured before and after reatment. Results The total efficiency of the observation group was 94. 74% , significantly higher than the control group 78. 95% , the difference was statistically significant （P 〈 0. 05） , the two groups after treatment of serum CRP and PCT levels were decreased significantly compared with before reatment, the observation group after treatment, serum CRP and PCT levels were （45. 19 ＋ 5. 79） mg/L and （ 1. 08 ＋ 0. 36） （jug/L was significantly ower than that before treatment and control group after treatment, the difference was statistically significant （P 〈0. 05） , the two groups after treatment of serum IL-6 and TNF-a levels were decreased significantly compared with before treatment, the observation group after treatment, serum IL-6 and TNF-a levels were （165. 29 ＋ 19. 23） pm/mL and （1. 16 ＋ 0. 25） pm/mL, was significantly lower than that before treatment and control group after reatment, the difference was statistically significant （P 〈0. 05） . Conclusion The inflammatory reaction in patients with ventilator-associated pneumonia ulinastatin can effectively reduce auxiliary patients, reduce inflammatory factors on lung injury, can alleviate the disease progression and to improve its prognosis.