乌司他丁联合肺泡复张法治疗非肺源性急性呼吸窘迫综合征

Ulinastatin combined with recruitment maneuver for extrapulmonary acute respiratory distress syndrome

目的探讨乌司他丁联合肺泡复张法治疗非肺源性急性呼吸窘迫综合征(ARDS)的临床疗效。方法选取我院2014年6月—2016年6月行乌司他丁联合肺泡复张法治疗的42例非肺源性ARDS患者为试验组,同期仅行肺泡复张法治疗的45例非肺源性ARDS患者为对照组。采用血气分析仪记录两组患者治疗前后的桡动脉氧分压(PaO2)、二氧化碳分压(PaCO2)和氧合指数(OI),呼吸机监测患者的吸气峰压(PIP)、气道平台压(Pplat)、肺静态顺应性(Cs)和肺动态顺应性(Cd),ELISA检测患者血清IL-6、TNF-α和IL-10的含量。结果试验组患者在治疗后第2、3、5、6、7天的桡动脉PaO2均高于对照组(P<0.05),治疗后第1、3、5、7天的PaCO2高于对照组(P<0.05),治疗后第6、7天的OI高于对照组(P<0.05)。与治疗前相比,两组患者治疗后的PIP、Pplat均下降(P<0.05),Cs、Cd均上升(P<0.05);但试验组患者治疗后PIP、Pplat、Cs和Cd的改变更加明显,与对照组相比差异有统计学意义(P<0.05)。与治疗前相比,对照组与试验组患者治疗后IL-6、TNF-α含量均下降(P<0.05),IL-10含量增加(P<0.05),试验组患者治疗后IL-6、TNF-α和IL-10含量较对照组相比差异有统计学意义(P<0.05)。结论与单纯肺泡复张法治疗相比,乌司他丁联合肺泡复张法可更为有效地改善ARDS患者的肺损伤和肺通气。

Objective To explore the clinical effect of ulinastatin combined with recruitment maneuver on extrapulmonary acute respiratory distress syndrome（ARDS）.Methods Forty-two patients with extrapulmonary ARDS,who received ulinastatin combined with recruitment maneuver in Eastern Hepatobiliary Surgery Hospital of Second Military Medical University from Jun.2014 to Jun.2016,were assigned to experimental group;and 45 patients with extrapulmonary ARDS,who were treated by recruitment maneuver without ulinastatin at the same time,were taken as control group.The blood gas analyzer was used to record radial arterial oxygen partial pressure（PaO2）,carbon dioxide partial pressure（PaCO2）and oxygenation index（OI）before and after treatment in the two groups;the breathing machine was used to record the inspiratory peak pressure（PIP）,plateau pressure（Pplat）,static lung compliance（Cs）and dynamic lung compliance（Cd）;and ELISA was used to detect the serum levels of IL-6,TNF-αand IL-10.Results PaO2 on 2nd,3rd,5th,6th and 7th day after treatment,PaCO2 on 1st,3rd,5th and 7th day after treatment,and OI on 6th and 7th day after treatment in the experimental group were higher than those in the control group（all P〈0.05）.After treatment,PIP and Pplat in the two groups were significantly decreased（P〈0.05）,and Cs and Cd were significantly increased（P〈0.05）;the changes in the experimental group were significantly greater compared with the control group（P〈0.05）.In the experimental group and the control group,IL-6and TNF-αlevels were significantly decreased（P〈0.05）,and IL-10 levels were increased（P〈0.05）after treatment;the changes in the experimental group were significantly greater compared with the control group（P〈0.05）.Conclusion Ulinastatin combined with recruitment maneuver can more effectively reduce lung injury and improve pulmonary ventilation of the patients with extrapulmonary ARDS compared with simple recruitment maneuver.