乌司他丁在创伤性急性肺损伤治疗中作用.docVIP

乌司他丁在创伤性急性肺损伤治疗中作用 　 作者：陆卫华， 许熹咏，唐忠志，陈忠庆，程青 【摘要】 目的 探讨乌司他丁对创伤性急性肺损伤的治疗作用。方法 选择60例创伤性急性肺损伤患者，随机分为乌司他丁治疗组(n=30)和对照组(n=30)，对照组接受常规治疗。乌司他丁治疗组在常规治疗基础上静脉滴注乌司他丁50 000 U/kg，1次/d，连用3 d，观察两组的临床疗效并检测治疗前及治疗第2天、第3天的血清TNFα、IL6和IL8水平变化。结果 乌司他丁治疗组与对照组在治疗前TNFα、IL6和IL8水平无差异。治疗后乌司他丁治疗组的TNFα、IL6和IL8水平下降较对照组明显(Plt;0. 05)。乌司他丁治疗组治疗后呼吸频率(RR)、氧分压(PaO2)、二氧化碳分压(PaCO2)，氧合指数(PaO2/FiO2)与对照组差异有统计学意义 (Plt;0. 05)。结论 乌司他丁可显著抑制机体炎症介质的产生，创伤性急性肺损伤早期应用治疗效果明显。 【关键词】 乌司他丁；创伤；急性肺损伤；细胞因子 Abstract： Objective To observe the therapeutic value in traumatic acute lung injury using ulinastatin.Methods Sixty patients with traumatic acute lung injury were randomly divided into ulinastatin group (n=30) and routine group (n=30). Both groups were given routine treatment, while the patients of the ulinastatin group were given ulinastatin (50,000 U/kg, intravenous drip, once per 24 hours, 3 days) in addition. The efficacy in both the groups were assessed, and their serum tumor necrosis factor (TNF)α, interleukin (IL)6 and IL8 levels were measured on the admission day and on the second and the third day. Results TNFα, IL6 and IL8 levels were not different between the two groups before treatment, but they reduced more significantly after treatment in the ulinastatin group than in the routine group (Plt;0.05). There were significantly differences in respiratory rate (RR), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and PaO2/FiO2 after treatment between the two groups (Plt;0.05).Conclusion Ulinastatin significantly inhibits the production of inflammatory cytokines. Early adminstration of ulinastatin can play an important role in the treatment of acute lung injury. Key words： ulinastatin; trauma; acute lung injury; cytokine 在现代社会中创伤已成为严重威胁人类健康的致病因素之一，其中由胸部外伤引起的肺损伤发生率占钝性胸外伤的30%～70%，死亡率为10%～20%。严重肺损伤易并发成人呼吸窘迫综合征(ARDS)，使死亡率明显上升[1～2]。乌司他丁（UTI）是从男性尿液中提取的丝氨酸蛋白酶抑制剂，相对分子质量为67 000，静脉滴注给药，其生物利用度达到100%。当机体受到休克、感染、手术等刺激时，尿液中UTI活性升高，表明机体通过增加UTI的浓度，以抵抗外来刺激对机体的损伤。目前已明确