乌司他丁治疗急性呼吸窘迫综合征的效果及其对血清炎性因子、血气指标的影响

Therapeutic effect of ulinastatin on acute respiratory distress syndrome and its influence on serum levels of IL-6 and ICAM-1

目的观察乌司他丁治疗急性呼吸窘迫综合征的效果及对血清炎性因子、血气指标的影响。方法将2015年4月—2017年4月成都市第二人民医院重症医学科收治的急性呼吸窘迫综合征患者96例作为研究对象,随机数字表法分为研究组和对照组各48例。2组患者常规治疗基础性疾病,对照组在常规治疗基础上行机械通气;研究组在对照组基础上联合应用乌司他丁注射液30万U溶入0.9%氯化钠注射液100 ml静脉滴注,2次/d。2组患者均连续治疗7 d。比较2组患者的临床效果、机械通气时间及住院时间;治疗前后血清炎性因子(TNF-α、IL-1β、IL-6、ICAM-1)、血气指标(SaO_2、PaO_2、PaCO_2)变化水平,并记录2组患者不良反应发生情况。结果治疗后研究组总有效率为93.7%,显著高于对照组的79.2%(χ~2=4.360,P=0.037);研究组机械通气时间、住院时间明显短于对照组(t=6.748、5.389,P=0.000、0.000);研究组TNF-α、IL-1β、IL-6、ICAM-1、PaCO_2水平显著低于对照组,SaO_2、PaO_2水平显著高于对照组(t=23.300、21.780、4.285、7.176、7.712、3.109、8.135,P=0.000、0.000、0.000、0.000、0.001、0.000、0.000);2组患者治疗过程发生恶心、呕吐、腹泻、皮疹不良反应发生率比较,差异无统计学意义(χ~2=1.098、0.443、0.218,P=0.295、0.506、0.641)。结论乌司他丁应用于急性呼吸窘迫综合征患者疗效确切,有效降低炎性因子水平,改善患者血气指标,安全可靠,值得临床推广应用。

Objective To observe the effect of ulinastatin on acute respiratory distress syndrome and its effects on serum IL-6 and ICAM-1.Methods Ninety-six cases of patients with acute respiratory distress syndrome were selected,which were treated in department of critical care medicine of the second people＆#39;s Hospital of Chengdu from April 2015 to April 2017, and they were divided into the study group（48 cases）and control group（48 cases）.The patients of all two groups were trea-ted with conventional treatment.The patients of control group were treated with mechanical ventilation, and on the basis of control group,the patients of study group were treated with ulinastatin injection（300 000 U dissolved in 100 ml 0.9%sodium chloride injection,intravenous infusion,2 times /d）.The patients of two groups were all treated for 7 days.The clinical effects,mechanical ventilation time, length of stay, adverse reactions and changes of the levels of TNF-α, IL-1β, IL-6, ICAM-1,SaO2,PaO2,PaCO2of two groups were compared.Results After the appropriate treatment, the patients of the study group got a total effective rate of 93.7%, which was significantly better than the 79.2% of the control group（χ2=4.360,P=0.037）;The mechanical ventilation time,length of stay of the study group were significantly lower than those of the control group（t=6.748,t=5.389,P=0.000,P=0.000）;The TNF-α, IL-1β, IL-6,ICAM-1 and PaCO2levels of the study group were significantly lower than those of the control group,while the SaO2,PaO2levels of the study group were significantly higher than those of the control group（t=23.300,t=21.780,t=4.285,t=7.176,t=7.712,t=3.109,t=8.135,P=0.000,P=0.000,P=0.000,P=0.000,P=0.001,P=0.000,P=0.000）;There were nausea,vomiting, diarrhea,rash and other adverse reactions occurred in both two groups,but there were no statistically significant between the two groups（χ2=1.098,χ2=0.443,χ2=0.218,P=0.295,P=0.506,P=0.641）.Conclusion The efficacy of ulinastatin in the treatment of acute respiratory distress syndrome is definite,can effectively reduce the levels of inflammatory factors IL-6, ICAM-1,improve the blood gas indicators of patients and it is safe,which makes it worthy of clinical application.