乌司他丁对脓毒性休克患者肺损伤防治作用临床研究.docVIP

乌司他丁对脓毒性休克患者肺损伤防治作用临床研究 　　[摘要] 目的：观察蛋白酶抑制剂乌司他丁对脓毒性休克患者肺损伤的防治作用并探讨其作用机制。方法:将脓毒性休克患者随机分成A、B两组，A组42例为治疗组，B组42例为对照组。两组患者均按照《拯救严重脓毒血症和感染性休克治疗指南》和《急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南》处理，A组加用乌司他丁20万U加生理盐水20 ml静脉注射，每8 h 1次，连续应用1周。分别观察两组患者的动脉血气分析、APACHE-Ⅱ评分和肺损伤Murray评分，计算多器官功能障碍综合征（MODS）发生率和病死率。结果:和B组比较，A组的氧合指数、APACHE-Ⅱ评分和MODS发生率明显改善（P＜0.05），肺损伤Murray评分和病死率下降不明显（P＞0.05）。结论：乌司他丁可以减轻脓毒性休克患者的肺损伤，保护肺功能，降低MODS发生率。 　　［关键词］ 乌司他丁； 急性肺损伤； 急性呼吸窘迫综合征； 脓毒性休克； 炎症反应 　　［中图分类号］ R541.64; R563.8 ［文献标识码］ A ［文章编号］ 1671-7562（2011）01-0041-04 　　doi:10.3969/j.issn.1671-7562.2011.01.省略 　　Clinical study of ulinastatin on lung injury in patients with septic shock 　　LI Jian-qiu, LAI Jian-bo, LIU Chen-feng, YAO Zhi-jun, CHEN Shao-lin, 　　CHEN Xing-wang, ZHOU Hua-feng, ZHANG Min-zhi 　　（Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University, Shenzhen 518104, China） 　　［Abstract］ Objective: To observe the effects of Ulinastatin on lung injury in patients with septic shock complicating with ALI or ARDS, and explore its mechanisms. Methods: Patients with septic shock complicating with ALI or ARDS were randomly divided into two groups: group A was treatment group（n42）, group B control group（n42）, who were treated according the Guideline of Rescuing Severe Septic Shock and the Guideline of the Diagnosis and Therapy for ALI/ARDS. The patients in group A received Ulinastatin 200,000 units intravenous every eight hours for one week. Parameters of arterial blood gas, oxygenation index（PaO2/FiO2）, acute physiology and chronic health evaluation-Ⅱ（APACHE-Ⅱ） score and lung injury Murrays score were measured respectively, and the rate of MODS and mortality were calculated. Results: In comparison with control group, PaO2/FiO2 , APACHE-Ⅱscore and the rate of MODS improved obviously（P＜0.05）， lung injury Murrays score and mortality didnt decrease obviously（P＞0.05） in treatment group. Conclusion: Trypsin inhibitors―Ulinastatin can mitigate lung injury, protect lung function and reduce the occurrence of MODS in pati