血必净和乌司他丁分别联合常规治疗慢性阻塞性肺疾病急性加重期合并全身炎症反应综合征疗效比较

Clinical Effectiveness Comparison of Xuebijing or Ulinastain Combined with Conventional Treatment for Chronic Obstructive Pulmonary Disease with Acute Exacerbation Complicated with Systemic Inflammatory Response Syndrome

目的:比较常规治疗基础上联合血必净或乌司他丁治疗慢性阻塞性肺疾病急性加重期(AECOPD)合并全身炎症反应综合征(SIRS)的临床疗效。方法:AECOPD合并SIRS患者82例随机分为A、B两组各41例,均给予常规治疗。在此基础上,A组加用乌司他丁30万U溶于0.9%氯化钠注射液100 ml,ivd,qd;B组加用血必净注射液50 ml加入0.9%氯化钠注射液100 ml,ivd bid。两组均治疗7 d为1个疗程。比较两组患者治疗前后肺功能、血气分析、炎症因子水平变化,以及药品不良反应。结果:治疗后,A、B两组FVC、FEV_1和FEV_1/FVC等肺功能指标均较治疗前显著提升(P<0.05),且B组明显高于A组(P<0.05);两组PaO_2、pH较治疗前明显升高,PaCO_2则明显下降(P<0.05),且B组PaO_2、pH明显高于A组,PaCO_2显著低于A组(P<0.05);两组APACHEⅡ评分和血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等炎症因子水平均较治疗前明显降低(P<0.05),且B组上述指标均低于A组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论:血必净和乌司他丁联合常规治疗AECOPD合并SIRS均有较好的临床效果;联合血必净注射液治疗,患者肺部功能及血气分析结果改善更明显,炎症因子水平降低更显著,临床应用安全。

Objective： To compare the clinical effect of Xuebijing or ulinastain combined with the conventional treatment for chronic obstructive pulmonary disease with acute exacerbation （AECOPD） complicated with systemic inflammatory response syndrome （SIRS）. Methods： Totally 82 AECOPD patients with SIRS were randomly divided into group A and group B with 41 ones in each and both groups were treated with the conventional therapy. Group A was treated with ulinastatin （ dissolved in 100 ml 0.9% sodium chloride injection, intravenous infusion, once daily）, group B was given 50ml Xuebijing injection （mixed with 100 ml saline, intravenous infusion, twice a day）. The lung function test, blood gas analysis and inflammatory factors were carried out in both groups. Results： After treatment, the lung function indices of FEV, FEV1 and FEV1/FVC in group A and B were significantly higher than those of before treatment （ P 〈 0.05 ） , and group B was significantly higher than group A （ P 〈 0.05 ）. Two groups of PaO2 and pH were significantly higher than those of before treatment, and PaCO2 was significantly decreased （ P 〈 0.05 ）. PaO2 and pH in group B were significantly higher than those in group A, and PaCO2 was significantly lower than that in group A （P 〈 0.05 ） The levels of APACHE II , TNF-α and IL-6 were significantly lower than those of before treatment （ P 〈 0.05 ）, and above indices in group B were lower than those in group A（ P 〈 0.05 ）. There was no significant difference in the incidence of adverse drug reactions between the two groups （ P 〉 0.05 ）. Conclusion： The clinical effect of Xuebijing or ulinastain combined with the conventional treatment is promising for AECOPD complicated with SIRS. Xuebijing injection combined with the conventional treatment shows better effect on the improvement of lung function and blood gas, and the levels of inflammatory cytokines can be reduced more significantly, which is also safe in the clinical application.