大剂量乌司他丁联合肺泡灌洗对重症肺炎患者疗效及血清炎症因子水平的影响

Effect of high-dose ulinastatin combined with bronchoalveolar lavage on efficacy and serum levels of inflammatory factors in patients with severe pneumonia

目的探讨大剂量乌司他丁联合肺泡灌洗治疗重症肺炎的疗效、安全性及对血清炎症因子水平的影响。方法将重症肺炎患者98例随机分为研究组和对照组各49例。在常规治疗的基础上,对照组行支气管肺泡灌洗,研究组行支气管肺泡灌洗的同时给予乌司他丁(10 000 U/kg)静脉滴注治疗,连续治疗7 d。比较两组治疗前、治疗后3 d及7 d的急性生理与慢性健康评估(APACHEⅡ)评分、血气分析、血清炎症因子水平,以及入院后7 d、28 d死亡情况和并发症发生情况。结果两组的Pa O2均随观察时间延长而升高,而APACHEⅡ评分、平均动脉压(MAP)、Pa CO2、血清白细胞介素(IL)-6、IL-10、肿瘤坏死因子(TNF)-α水平及血浆C-反应蛋白(CRP)水平随观察时间延长而降低(均P<0.05);治疗后3 d和治疗后7 d,研究组的Pa O2分别高于对照组(P<0.05),且APACHEⅡ评分、MAP、Pa CO2、血清IL-6、IL-10、TNF-α水平及血浆CRP水平均低于对照组(P<0.05)。研究组7 d和28 d死亡者比例均低于对照组(P<0.05)。两组消化道反应、瘙痒发生率及并发症总发生率比较,差异均无统计学意义(P>0.05)。结论与单纯支气管肺泡灌洗比较,在常规治疗的基础上应用大剂量乌司他丁联合肺泡灌洗治疗重症肺炎可有效控制患者炎症反应、改善其肺功能及预后,安全性良好。

Objective To investigate the efficacy and safety of high-dose ulinastatin combined with bronchoalveolar lavage and its effect on the serum levels of inflammatory factors in patients with severe pneumonia. Methods Ninety-eight patients with severe pneumonia were randomly divided into study group（ n = 49） and control group（ n = 49）. On the basis of conventional therapy,the control group underwent bronchoalveolar lavage,and the study group underwent bronchoalveolar lavage and was intravenously administered ulinastatin（ 10 000 U/kg）.Both groups were continuously treated for 7 days. Before treatment,on the 3 rd and 7 th day after treatment,the score of Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHE Ⅱ）,blood gas analysis and serum levels of inflammatory factors were compared between the two groups. The mortalities on the 7 th and 28 th day after hospitalization and the incidence of complications were also compared between the two group. Results In both groups,the Pa O2 levels increased with the increasing observation time,and APACHE Ⅱscore,mean arterial pressure（ MAP）,Pa CO2,serum interleukin（ IL）-6,IL-10,tumor necrosis factor（ TNF）-α and plasma C-reactive protein（ CRP） levels decreased with the increasing observation time（ all P〈0. 05）. After 3 and 7 days of treatment,the Pa O2 levels of the study group were higher than those of the control group（ P〈0. 05）,and APACHEⅡscore,MAP,the levels of Pa CO2,serum IL-6,IL-10,TNF-α and plasma CRP of the study group were lower than those of the control group（ all P〈0. 05）. The 7-day and 28-day mortalities of the study group were lower than those of the control group（ all P〈0. 05）. There were no significant differences in the incidence rate of gastrointestinal reaction or itching,or the total incidence rate of complications between the two groups（ P〈0. 05）. Conclusion Compared to the bronchoalveolar lavage alone,the administration of high-dose ulinastatin combined with bronchoalveolar lavage on the basis of conventional therapy can effectively control the inflammatory response,improve lung function and prognosis,and achieve a good safety for treating severe pneumonia.