无创机械通气联合乌司他丁治疗ARDS患者疗效及安全性分析

Clinical effect and safety of noninvasive mechanical ventilation combined with ulinastatin in treatment of patients with ARDS

目的探讨无创机械通气联合乌司他丁治疗ARDS患者疗效及安全性。方法收集2011年3月至2015年3月间我院收治的ARDS患者82例作为研究对象，采用随机数字表法将其分为观察组及对照组各41例。对照组患者使用无创机械通气进行治疗，观察组患者在此基础上加用乌司他丁进行治疗。对2组患者临床疗效、动脉血气指标、炎性因子水平、安全性以及生活质量进行观察与比较。结果观察组患者治疗总有效率（92．68％）远高于对照组（70．73％），差异有统计学意义（X^2=6．609，P〈0．05）。2组患者治疗后PaO2、SaO2以及Pa02／FiO2均较治疗前明显上升，PaCO2较治疗前明显下降，观察组变化幅度更加显著（P〈O．05）。2组患者治疗后肿瘤坏死因子a、IL-6、超敏C反应蛋白及血管内皮生长因子均较治疗前明显下降，且以观察组下降幅度更加显著（P〈0．05）。观察组患者不良反应发生率为7．32％，对照组为2．44％，2组患者安全性比较差异无统计学意义（X^2=1．051，P〉0．05）。观察组患者生活质量提高总有效率（90．24％）显著高于对照组（65．85％），差异有统计学意义（X^2=7．118，P〈0．05）。结论无创机械通气联合乌司他丁治疗ARDS具有良好的疗效及安全性，可明显降低炎性因子水平、提高患者生活质量，值得临床推广应用。

Objective To explore the clinical effect and safety of noninvasive mechanical ventilation combined with ulinastatin in treatment of patients with acute respiratory distress syndrome （ARDS）. Methods Eighty-two patients with ARDS accepted in our hospital from Mar. 2011 to Mar. 2015 were selected and randomly divided into observation group and control group with 41 cases in each. Patients in control group underwent noninvasive mechanical ventilation, while in observation group accepted ulinastatin additionally. Then the clinical effect, indexes of arterial blood gases （ABG）, expression levels of inflammatory factors, safety and life quality of two groups were compared. Results The total efficacy of observation group （92.68%） was obviously higher than control group （70.73%） with statistically significance （ P 〈0.05）. PaO2, SaO2 and PaO2/FiO2 of two groups were getting higher while PaCO2 was getting lower after treatment and had obviously difference compared to before treatment, among which the variety of observation group was much more greater than control group with statistically significance （P〈0.05）. The expression level of TNF-α, IL-6, hs-CRP and VEGF were getting lower after treatment compared to before, among which the variety of observation group was much more greater than control group with statistically significance （ P 〈0.05）. The adverse reaction rate of observation group was 7.32%, which had no difference compared to 2.44% of control group （ P〉0.05）. The improvement rate of life quality of observation group （90.24%） was remarkably higher than control group （65.85% ） with statistically significance （ P 〈0.05 ）. Conclusions Using noninvasive mechanical ventilation combined with ulinastatin has good efficacy and safety in treatment of patients with ARDS. It can reduce the expression level of infammatory factors and improve the life quality, which is worth of clinical applications.