乌司他丁联合氨溴索治疗胸外伤所致ALI/ARDS的临床研究(1)
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【摘要】 目的 探讨乌司他丁联合氨溴索在胸外伤所致ALI/ARDS患者中的治疗效果和作用。方法 选取60例胸外伤所致ALI/ARDS的患者进行研究,随机分为:A(对照组)、B(氨溴索治疗组)、C(乌司他丁联合氨溴索治疗组)三组。测定各组患者治疗前后PaO2、PaO2/FiO2、血浆IL-6水平变化。结果 B组患者各项指标均优于A组,通气24 h后C组氧分压及氧合指数较B组改善,IL-6水平较B组降低,且较A组差异有统计学意义。结论 氨溴索联合乌司他丁能较好减轻肺损伤程度,改善氧合,较单存使用氨溴索更为有益,两者均是急性肺损伤时的有效治疗药物。
【关键词】机械通气;乌司他丁;IL-6
Clinical research ment of ALI/ARDS caused by thoracic trauma with ulinastatin and ambroxol
LU Wen,YANG Cong,LI jin-lai,et al.Department of ICU,Zaozhuang Municipal Hospital,Shangdong Zaozhuang 277100,China
【Abstract】 Objective To investigate the effect of ulinastatin combined with ambroxolin mechanical ventilation after chest trauma,wether this combination could relieve lung injury preferably compared with ambroxol only.Methods 60 patients were allocated into three groups.Group A(n=20)received mechanical ventilation routinely.Group B(n=20),which is compared group.were injected with some dose of ambroxol while mechanical ventilation.Treatment group (group C,n=20) were injected with ulinastatin and ambroxol while mechanical ventilation.PaO2 and PaO2/FiO2 were measured by blood gas analysis,the content of IL-6 in plasma was mwasured by PCR during each time.Results Each markets of Group B was superto roup A.Compard with Group A,oxygen press and oxygenation index of Group B were improved,the contents of IL-6 in plasma were descented.the difference between Group B and Group A was significant.Conclusion Ambroxol associated with ulinastatin could better relieve the level of acute lung injury,ameliorating oxygenation,which could get more benefit than ambroxol only,and both were remedial drugs efficiently.
【Key words】Mechanical ventilation;Ulinastatin;IL-6
随着社会发展,胸部外伤屡见不鲜,成为致死的重要原因。胸部外伤后的急性炎症反应导致急性肺损伤/急性呼吸窘迫综合征(ALI/ARDS)。氨溴索在抗急性肺损伤中的作用已得到认可,但乌司他丁联合氨溴索在急性肺损伤中的作用还未意识到,IL-6是促炎因子在急性肺损伤中起到非常重要的作用,其浓度与肺损伤程度呈正相关。本文旨在观察二者联合应用在ALI/ARDS的作用及对IL-6影响,探讨更好减轻肺损伤的方法。
1 资料与方法
1.1 一般资料 随机选取60例因严重胸外伤后需要呼吸机支持患者,其中男33例,女27例,年龄15~72岁,挤压伤25例,坠落伤18例,重物直接砸伤17例。其中多根多处肋骨骨折39例,单纯肋骨骨折致血气胸10例,气胸11例。机械通气前PaO2<60 mm Hg,CT示不同程度的肺渗出性病变。两组年龄无统计学差异,均不合并其他疾病。
1.2 急性处理 行机械通气前过胸腔闭式引流、胸带固定、补液等措施,处理血气胸、反常呼吸、创伤性休克等,通解决。
1.3 方法
1.3.1 分组 分为:A组:单纯行机械通气治疗;B组:机械通气同时给予一定剂量的氨溴索(30 mg、辽宁天龙药业有限公司);C组:机械通气同时给予乌司他丁(10万U、广东天普生化医药股份有限公司)联合氨溴索,每组各20例 ......
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