乌司他丁治疗严重肺挫伤患者的疗效探讨

Study on Curative Effect of Ulinastatin in Treatment of Patients with Severe Pulmonary Contusion

目的观察乌司他丁对严重肺挫伤患者的临床疗效的影响。方法选择2014年1月—2016年12月上海交通大学医学院附属苏州九龙医院重症医学科41例严重肺挫伤患者,将其随机分为两组,其中实验组22例,对照组19例。两组患者在治疗过程中的治疗原则均相同,在此基础上,实验组加用乌司他丁(天普生化医药股份有限公司)30万U,静脉注射,每8小时1次,连用3 d。观察两组患者呼吸机使用时间、肺部啰音消失时间、住ICU时间、APACHEII评分、治疗后第3天(d3)的Murray评分、白细胞计数、C反应蛋白(CRP)、降钙素原(PCT)、氧合指数(PO_2/FiO_2)、二氧化碳分压(Pa CO_2)、并发症的发生情况(包括需行气管切开、并发纵膈气肿、气胸、肺炎、死亡等)等指标。结果实验组与对照组相比,在呼吸机使用时间[(3.77±2.29)d vs(6.95±5.82)d],住ICU时间[(4.73±1.12)d vs(8.79±6.40)d],d3的Pa CO_2[(39.20±5.43)mm Hg vs(45.54±13.20)mm Hg]、Murray评分[(0.51±0.50)分vs(0.95±0.59)分]、氧合指数(PO_2/FiO_2)(314.14±75.97)vs(229.37±151.54),以上指标二组之间差异有统计学意义(P>0.05)。而在肺部啰音消失时间[(2.00±0.82)d vs(2.47±2.20)d]、APACHEII评分[(15.32±6.51)分vs(15.16±5.75分)]、d3的白细胞计数[(9.37±4.02)×109/L vs(10.84±5.28)×109/L]、C反应蛋白[(36.82±25.46)mg/L vs(43.32±47.86mg/L)]、降钙素原[(3.49±3.18)ng/m L vs(4.73±6.30)ng/m L]、并发症的发生情况等方面,两组之间差异无统计学意义(P>0.05)。结论乌司他丁治疗严重肺挫伤有较好的治疗效果,值得临床推广应用。

Objective To observe the curative effect of Ulinastatin in treatment of patients with severe pulmonary contusion. Methods 41 cases of patients with severe pulmonary contusion admitted and treated in our hospital from January 2014 to December 2016 were selected and randomly divided into the experimental group with 22 cases and the control group with 19 cases, both groups had the same treatment principle during the treatment course, and the experimental group added the ulinastatine（General Biochemistry Pharmaceutical co., LTD） 300 thousand U and adopted the intravenous injection once every eight hours for the consecutive three days, and the respirator use time, lung rale disappearance time, ICU time, APACHEII score, Murray score at 3 d after treatment, white blood cell count, CRP, PCT,PO 2/FiO 2 and PaCO 2 and occurrence of complications（included the tracheotomy, complicated by mediastinal emphysema, pneumothorax, pneumonia, death） indexes of the two groups were observed. Results The differences in the respirator use time, ICU time, PaCO2 at 3 d, Murray score and POa/FiO： between the experimental group and the control group were obvious with statistical significance（3.77±2.29）d vs （6.95±5.82）d, （4.73±1.12）d vs （8.79±6.40）d, （39.20±5.43） mmHg vs （45.54±13.20）mmHg,（0.51±0.50）points vs （0.95±0.59）points, （314.14±75.97） vs （229.37±151.54） （P〈0.05） , but the differences in the lung rale disappearance time, APACHEII score, white cel l count at 3 d, C reactive protein, procalcitonin and occurrence of complications between the experimental group and the control group were not statisti-cally significant（2.00±0.82）d vs （2.47±2.20）d, （15.32±6.51）points vs （15.16±5.75）points,（9.37±4.02）×10^9/L vs （10.84± 5.28）×10^9/L, （36.82±25.46） mg/L vs （43.32±47.86） mg/L, （3.49±3.18）ng/mL vs （4.73±6.30）ng/mL, and the differences between the two groups were statistically signif icant （P〉0.05） . Conclusion The effect of ulinastatin in treatment of pa-tients with severe pulmonary contusion is better, which is worth cl inical promotion and application.