心搏骤停患者经心肺复苏抢救自主循环恢复后使用大剂量乌司他丁在改善预后中的效果

Clinical effect of high doses of ulinastatin after cardiopulmonary resuscitation restoration of spontaneous circulation for patients with cardiac arrest

目的探讨心搏骤停患者经心肺复苏抢救自主循环恢复(restoration of spontaneous circulation,ROSC)后使用大剂量乌司他丁在改善预后中的效果。方法按照是否接受乌司他丁治疗将81例心脏骤停患者分为试验组41例(常规方案+大剂量乌司他丁)和对照组40例(常规方案),观察两组患者ROSC后心肌酶指标[肌酸激酶同工酶(Creatine Kinase-MB,CK-MB)、α-羟丁酸脱氢酶(α-hydroxybutyrate dehydrogenase,HDBH)]、白蛋白(Albumin,Alb)和乳酸(Lactic acid,Lac)、肝功能指标[丙氨酸转氨酶(Alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)]、肾功能指标[血尿素氮(Blood urea nitrogen,BUN)、血肌酐(Creatinine,Cr)]水平及多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)严重度评分变化情况,并比较两组患者ROSC后4周脑功能分级和生存情况。结果试验组患者ROSC后24h、48h、72h CK-MB、HDBH水平显著低于对照组,有统计学差异(P<0.05);试验组患者ROSC后24h、48h、72h Lac水平均显著低于对照组,有统计学差异(P<0.05);试验组患者ROSC后24h、48h、72h ALT、AST水平显著低于对照组,有统计学差异(P<0.05);试验组患者ROSC后48h、72h BUN水平显著低于对照组,ROSC后24h、48h、72h Cr水平显著低于对照组,有统计学差异(P<0.05);试验组患者ROSC后24h、48h、72h MODS评分均显著低于对照组,有统计学差异(P<0.05);试验组患者ROSC后4周脑功能分级1-2级所占比例略高于对照组,但无统计学差异(P>0.05);试验组患者ROSC后4周死亡率略低于对照组,但无统计学差异(P>0.05)。结论心搏骤停患者经心肺复苏抢救ROSC后使用大剂量乌司他丁能够有效提高患者心功能、肝肾功能、Alb和Lac改善效果,减轻MODS严重度,对改善脑功能分级和降低死亡率也有一定积极作用。

Objective To explore the clinical effect of high doses of ulinastatin after cardiopulmonary resuscitation restoration of spontaneous circulation for patients with cardiac arrest. Methods 81 patients with cardiac arrest were divided into the experiment group( conventional scheme + high doses of ulinastatin) and the control group( conventional scheme). The levels of CK-MB,HDBH,Alb,Lac,ALT,AST,BUN,Cr,and the scores of MODS were observed. Results The levels of CK-MB and HDBH on 24 h,48 h,72 h after ROSC for the experiment group were lower than the control group( P < 0. 05). The levels of Lac,ALT,AST,BUN and Cr on 24 h,48 h,72 h after ROSC for the experiment group were lower than the control group( P < 0. 05). The scores of MODS on 24 h,48 h,72 h after ROSC for the experiment group were lower than the control group( P < 0. 05). There was no significant difference in the rate of brain function classification 1-2 or mortality( P > 0. 05). Conclusion It can increase the heart,liver and kidney function for the patients with cardiac arrest by high doses of ulinastatin after cardiopulmonary resuscitation restoration of spontaneous circulation,improve the levels of Alb,Lac,and reduce the MODS. It also has some positive effect on brain function classification and mortality reduce.