中国循证医学杂志

中国循证医学杂志

大剂量乌司他丁联合肺保护性通气对危重疾病合并急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者呼吸功能的影响

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目的 探讨大剂量乌司他丁联合肺保护性通气对危重疾病合并急性肺损伤/急性呼吸窘迫综合征患者呼吸功能的影响。 方法 采用回顾性方法,分析安徽医科大学第二附属医院重症医学科(ICU)危重疾病合并急性肺损伤/急性呼吸窘迫综合征患者资料,根据是否使用大剂量乌司他丁联合保护性通气治疗,分为治疗组和对照组;记录患者治疗过程中的肺毛细血管通透指数(pulmonary vascular permeability index,PVPI)、血管外肺水指数(extravascular lung water index,EVLWI)、氧合指数、患者全身炎症反应持续天数、ICU 入住天数及APACHE Ⅱ评分等指标。采用 SPSS 19.0 软件进行统计分析。 结果 共纳入患者 24 例,治疗组 13 例,对照组 11 例。治疗 72 小时后,治疗组患者肺毛细血管通透指数(P=0.016)、血管外肺水指数(P=0.045)、全身炎症反应持续时间(P=0.002)、ICU 停留时间(P=0.024)以及APACHE Ⅱ(P=0.002)均较对照组明显降低,而氧合指数较对照组显著升高(P=0.004)。 结论 大剂量乌司他丁联合保护性通气治疗能降低危重患者全身炎症反应,显著改善危重疾病患者合并急性肺损伤/急性呼吸窘迫综合征患者肺毛细血管通透性,减少毛细血管渗漏,减少血管外肺水,从而改善患者肺氧合情况,降低患者 ICU 入住时间,改善患者的预后。

Objective To investigate the effects of high dose ulinastatin with lung protective ventilatory strategies on respiratory function and prognosis in critical disease patients combined with acute lung injury/acute respiratory distress syndrome. Methods Using retrospective analysis, we involved the critical disease patients combined with ALI/ARDS in ICU of The Second Affiliated Hospital of Anhui Medical University. According to whether they were treated with high dose ulinastatin with lung protective ventilatory strategies or not, the patients were divided into the treatment group and the control group. Then pulmonary vascular permeability index (PVPI), extravascular lung water index (EVLWI), oxygenation index, length of SIRS, length of stay in ICU and APACHE Ⅱ score were observed. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 24 patients were included, 13 cases in the treatment group and 11 cases in the control group. After 72 h, PVPI (P=0.016), EVLWI (P=0.045), length of SIRS (P=0.002), length of stay in ICU (P=0.024) and APACHE Ⅱ score (P=0.002) decreased significantly, while oxygenation index (P=0.004) increased significantly in the treatment group compared with the control group. Conclusion High dose ulinastatin with lung protective ventilatory strategies decreased lung capillary permeability, reduced lung blood capillary leakage and extravascular lung water, resulted in the improvement of lung oxygenation function, decreased of length of stay in ICU and the improvement of prognosis in critical disease patients combined with acute lung injury/acute respiratory distress syndrome.

关键词: 乌司他丁; 急性肺损伤/急性呼吸窘迫综合征; 肺毛细血管通透性; 血管外肺水指数

Key words: Ulinastatin; ALI/ARDS; PVPI; ELWI

引用本文: 华天凤, 尹路, 李惠, 郑瑶, 张频捷, 杨旻. 大剂量乌司他丁联合肺保护性通气对危重疾病合并急性肺损伤(ALI)/急性呼吸窘迫综合征(ARDS)患者呼吸功能的影响. 中国循证医学杂志, 2017, 17(4): 379-382. doi: 10.7507/1672-2531.201612096 复制

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