乌司他丁联合持续血液净化治疗在急性呼吸窘迫综合征患者中的应用效果

Application effect of Ulinastatin combined with continuous blood purification in patients with acute respiratory distress syndrome

目的探讨乌司他丁与持续血液净化联合治疗急性呼吸窘迫综合征(ARDS)对患者内皮功能与血清炎性因子水平的影响。方法按随机数字表法将武汉亚洲心脏病医院2019年9月至2021年9月收治的120例ARDS患者分为对照组和观察组,各60例。两组患者均进行常规治疗(氧疗、糖皮质激素、维持内环境稳定、肺保护机械通气及积极治疗原发性疾病等),在此基础上对照组患者采用持续血液净化治疗(共治疗3 d),观察组患者在对照组的基础上联合乌司他丁治疗(共治疗7 d)。比较两组患者的机械通气时间、重症加强护理病房(ICU)住院时间,治疗后的急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分;比较两组患者治疗前后的内皮功能、炎性因子及血清钙结合蛋白S100A12、诱骗受体3(DcR3)水平。结果治疗后,观察组患者APACHEⅡ评分低于对照组,机械通气时间和ICU住院时间均短于对照组;与治疗前比较,治疗后两组患者呼气冷凝液一氧化氮(NO)及血清NO、白细胞介素-10(IL-10)水平均升高,且观察组均高于对照组;治疗后两组患者呼气冷凝液内皮素(ET-1)及血清ET-1、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、S100A12、DcR3水平均降低,且观察组均低于对照组(均P<0.05)。结论乌司他丁与持续血液净化联合治疗ARDS可有效缩短患者ICU住院与机械通气时间,改善其血管内皮的通透性,同时能够减轻机体的炎症反应,纠正肺泡水肿,进而缓解患者的临床症状,促进患者恢复。

Objective To investigate the effect of Ulinastatin combined with continuous blood purification on endothelial function and serum inflammatory factor levels in the treatment of acute respiratory distress syndrome(ARDS).Methods According to the random number table method,120 ARDS patients admitted to Wuhan Asia Heart Hospital from September 2019 to September 2021 were divided into the control group and the observation group,with 60 cases in each group.Patients in both groups were treated with conventional treatment(oxygen therapy,glucocorticoids,maintenance of homeostasis,lung protection,mechanical ventilation and active treatment of primary diseases,etc.),and on these basis,patients in the control group received continuous blood purification treatment(the treament course was 3 d),patients in the observation group were treated with Ulinastatin on the basis of the control group(the treament course was 7 d).The mechanical ventilation time,intensive care unit(ICU)length of stay,acute physiology and chronic health statusⅡ(APACHEⅡ)score after treatment were compared between the two groups;the endothelial function,inflammatory factors,serum calcium binding protein S100A12 and decoy receptor 3(DcR3)levels were compared between the two groups before and after treatment.Results After treatment,the APACHEⅡscore of the observation group was lower than that of the control group,and the mechanical ventilation time and ICU length of stay were shorter than those of the control group;compared with before treatment,exhaled condensate nitric oxide(NO),serum NO and interleukin-10(IL-10)levels after treatment of the two groups of patients increased,and the observation group was higher than the control group;after treatment,the exhaled condensate endothelin(ET-1)and serum ET-1,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),S100A12 and DcR3 levels decreased,and the observation group was lower than the control group(all P<0.05).Conclusion Ulinastatin combined with continuous blood purification in the treatment of ARDS can effectively shorten the ICU length of stay and mechanical ventilation time,improve the permeability of the vascular endothelium,reduce the body's inflammatory response,correct alveolar edema,relieve the clinical symptoms of the patient and promote the recovery of the patient.