乌司他丁用于开胸术后全身炎症反应综合征患者的临床研究

Therapeutical effects of Ulinastatin on systemic inflammatory response syndrome in the patients after thoracotomy

目的 观察乌司他丁 (Ulinastatin ,UTI)对开胸手术后合并全身炎症反应综合征 (SIRS)患者IL - 6、IL - 10、TNF-α及C -反应蛋白 (CRP)的影响 ,以寻求一种调控机体炎症反应的有效途径。方法 30例开胸手术后确诊合并SIRS的患者随机分为两组 ,对照组 (B组 ,n =15 )接受常规的抗SIRS及其他综合治疗 ,试验组 (A组 ,n =15 )在同样接受B组治疗方法的基础上接受UTI 10万Uiv q8h× 5d。常规监测患者心率 (HR)、呼吸频率 (RR)、体温 (T)、白细胞计数 (WBC)、SIRS炎症症状改善时间等 ,并于治疗前及治疗后第 3、5、7天抽静脉血检测血清IL - 6、IL - 10、TNF -α、CRP水平。结果 两组治疗前各项指标无显著性差异 (P >0 0 5 ) ,但治疗后第 3天A组即出现血浆CRP、IL - 6、TNF -α水平及T、RR、HR、WBC等观测指标的显著降低 ,B组的上述指标于治疗后第 5天才开始出现降低 ,但降低的幅度明显小于A组 (P <0 0 1)。A组治疗后第 5天IL - 10开始明显上升 (P <0 0 5 ) ,而B组治疗前后变化不大 (P >0 0 5 )。另外 ,A组患者治疗后SIRS炎性指标超过 3d无明显改善者较B组明显减少 (P <0 0 5 ) ,MODS的发生率明显降低 (P <0 0 5 )。结论 乌司他丁可能通过调控抗炎因子和促炎因子的平衡 。

Objective To look for an efficient method to adjust the systemic inflammatory responses to prevent the patients with systemic inflammatory response syndrome(SIRS) after thoracotomy from changing into multiple organ dysfunction syndrome (MODS). Methods 30 post-thoracotomy patients with SIRS were randomly divided into regular treatment group (group B,n=15) and Ulinastatin treatment group (group A,n=15). Both groups were given regular treatment,while the group A were given Ulinastatin (100 000U,iv,Q8h,and continue to 5days) additionally. Temperature (T),heart rate (HR),respiration rate (RR) and white blood cell (WBC) were observed every day and the serum levels of CRP,TNF-alpha,IL-6 and IL-10 were measured before treatment,3 d,5 d and 7 d after treatment. Results All of the SIRS markers had no significant difference between group A and B before treatment. The serum levels of CRP,IL-6,TNF-alpha and the data of T,RR,HR and WBC were significantly reduced at the 3rd day after treatment in group A(P<0.01). The above-mentioned indexes didn't reduce untill 5th day in group B,and the speeds were also slower than group A ( P <0.01). The serum levels of IL-10 increased significantly at the 5th day in group A (P<0.05),but it didn't change at all the points in group B(P>0.05). The duration of SIRS markers for more than 3days were fewer in group A than those in group B (χ 2=5.37,P <0.05),the incidence rates of MODS were also significantly lower than group B ( P <0.05). Conclusion The balances between anti-inflammatory response and inhibitory inflammatory response could be controlled by Ulinastatin efficiently,it could also prevent those patients from changing into MODS efficiently.