乌司他丁对心肺复苏后患者肾功能的保护作用

Protective effect of ulinastatin on renal function in patients after cardiopulmonary resuscitation

目的观察乌司他丁(UTI)对心肺复苏后患者肾功能的影响。方法选取2015年1月至2016年7月我院急诊抢救和重症医学科收治的80例心脏骤停经心肺复苏后自主循环恢复(ROSC)患者为研究对象,按照治疗方案分为观察组(n=40)和对照组(n=40),两组均给予心肺复苏常规治疗,观察组加注射UTI,1周后检测两组患者第0、1、3、5、7天内的尿量、尿蛋白、血清肌酐(Scr)、血尿素氮(BUN)及相关炎症因子水平[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)和白介素-10(IL-10)];记录少尿持续时间、尿蛋白转阴时间及治疗前后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ评分)、序贯器官衰竭评估(SOFA)评分,统计ICU住院时间、行连续肾脏替代疗法(CRRT)治疗人数、急性肾损害(AKI)人数和28 d死亡人数。结果治疗后第1、3、5、7天,观察组各时间点尿量明显多于对照组,而尿蛋白、BUN、Scr、TNF-α、IL-6和IL-10指标均明显低于对照组,差异均有统计学意义(P<0.05);观察组少尿持续时间、尿蛋白转阴时间、Scr和BUN恢复正常时间、APACHEⅡ评分和SOFA评分均明显低于对照组,差异均有统计学意义(P<0.05);观察组ICU住院时间为(15.3±8.5)d,明显短于对照组的(26.9±10.6)d,AKI发生率为10.0%,明显低于对照组的32.5%,28 d死亡率为17.5%,明显低于对照组40.0%,差异均有统计学意义(P<0.05),而两组患者行CRRT治疗率比较差异无统计学意义(P>0.05)。结论乌司他丁能够通过降低炎症反应来保护肾脏,降低心肺复苏后患者的急性肾损伤的发生率。

Objective To investigate the effect ofulinastatin （UTI） on renal function in patients after cardiopulmonary resuscitation. Methods A total of 80 cases of patients with restoration of spontaneous circulation （ROSC） after cardiopulmonary resuscitation for sudden cardiac arrest, who rescued by emergency and admitted to ICU of our hospital from January 2015 to July 2016, were enrolled and divided into the observation group （n=40） and the control group （n= 40） according to the treatment plan. Both groups were given conventional treatment of cardiopulmonary resuscitation, and the observation group were additionally treated with injection of UTI. One week later, the urine volume, urinary protein, serum creatinine （Scr）, blood urea nitrogen （BUN） and levels of related inflammatory factors （tumor necrosis factor [TNF-α], interleukin-6 [IL-6] and interleukin 10 [IL-10]） in the two groups on the day 0, on the 1^st, 3^rd, 5^th and 7^th day were detected. The duration of oliguria, time of negative conversion of urinary protein, scores of acute physiology and chronic health evaluation （APACHE） and sequential organ failure assessment （SOFA） before and after treatment were recorded. The length of stay in ICU, number of patients undergoing continuous renal replacement therapy （CRRT） and 28 d mortality rates were analyzed statistically. Results On the 1^st, 3^rd, 5^th and 7^th day after treatment, the urine vol- ume of observation group was significantly more than that of control group, while urinary protein, BUN, Scr, TNF-α, IL-6 and IL-10 were significantly lower than those in control group （P〈0.05）. The duration of oliguria, time of negative conversion of urinary protein, time of Scr and BUN returning to normal level, APACHE Ⅱ scores and SOFA scores in the observation group were significantly lower than those in the control group （P〈0.05）. The length of stay in ICU, the incidence of AKI and 28 d mortality rate in the observation group were （15.3±8.5） d, 10.0%; 17.5%, respectively, which were significantly shorter or lower than corresponding （26.9±10.6） d, 32.5%, 40.0% in the control group （P〈0.05）, but there was no significant difference in the rate of CRRT between the two groups （P〉0.05）. Conclusion Ulinastatin can protect the renal function and reduce the incidence of acute kidney injury after cardiopulmonary resuscitation by reducing the inflammatory responses.