乌司他丁治疗重型创伤性湿肺的临床观察体会(1)
【摘要】 目的：探究重型创伤性湿肺患者临床以乌司他丁治疗，患者疾病治疗效果以及呼吸通气情况恢复情况。方法：选取本院2015年9月-2017年5月期间收治的64例重型创伤性湿肺者为研究对象，按随机排列表法将患者分为两组，每组各32例。对照组行常规支持治疗及肺保护通气，观察组加用乌司他丁，比较治疗前后患者氧动力学指标[动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)]、呼吸动力学指标[呼吸频率(RR)、气道平均压(Mpaw)、气道峰压(PIP)]变化情况，对疾病治疗效果进行评估，统计患者住ICU时间、肺挫伤程度、镇痛镇静剂使用量以及脱机时间。结果：观察组治疗总有效率为93.8%，优于对照组81.3%，两组比较差异有统计学意义(P<0.05)。入院时RR、PaO2/FiO2、PaO2、Mpaw、PIP、PaCO2指标组间比较差异均无统计学意义(P>0.05)；治疗后观察组指标水平改善效果均优于对照组，两组比较差异均有统计学意义(P<0.05)。与对照组比较，观察组脱机、住ICU时间短，镇静镇痛用药少且肺挫伤程度低，两组比较差异均有统计学意义(P<0.05)。结论：临床对重型创伤性湿肺患者治疗时，在常规基础治疗上加用乌司他丁，能提高疾病治疗效果，促进患者氧动力学、呼吸动力学恢复，减轻肺挫伤程度。
, http://www.100md.com
【关键词】 疗效； 乌司他丁； 创伤性湿肺； 重型
Clinical Observation of Ulinastatin in the Severe Traumatic Wet Lung/YANG Gen.//Medical Innovation of China，2018，15(01)：010-013
【Abstract】 Objective：To explore the clinical effect of Ulinastatin in the respiration ventilation for patients with severe traumatic wet lung.Method：64 patients with severe traumatic wet lung treated from September 2015 to May 2017 in our hospital were selected.The subjects were randomly divided into two groups，32 cases in each group.The control group received the conventional therapy and protective ventilation，the observation group also took Ulinastatin.Before and after treatment，the oxygen dynamic index (PaO2，PaCO2，PaO2/FiO2) and pneodynamics index (RR，Mpaw，PIP) of two groups were compared；the ICU duration time，pulmonary contusion，usage amount of analgesia and sedative agents and weaning time of two groups were observed.Result：The total effective rate in observation group was 93.8% higher than control group of 81.3%，the difference was statistically significant(P<0.05).Upon admission to hospital，the clinical indexes of RR， PaO2/FiO2，PaO2，Mpaw，PIP and PaCO2 of two groups were not significantly different(P>0.05)；after treatment，the above index for observation group were better than control group(P<0.05).The weaning time， ICU duration time and usage amount of analgesia and sedative agents and pulmonary contusion in observation group were better than control group (P<0.05).Conclusion：For patients with severe traumatic wet lung，the conventional therapy and Ulinastatin can improve the clinical effect，promote the recovery of oxygen dynamics and pneodynamics，reduce the pulmonary contusion.
, 百拇医药
【Key words】 Clinical effect； Ulinastatin； Traumatic wet lung； Severe
First-author’s address：Lianjiang People’s Hospital，Lianjiang 524400，China
doi：10.3969/j.issn.1674-4985.2018.01.003
重型創伤性湿肺为患者胸部开放性或闭合性创伤造成肺组织充血、水肿、出血，表面活性物质缺失，通气与血流比例失衡所致[1]。患者临床表现为药物无法纠正的低氧血症以及急性呼吸窘迫综合征，若不及时治疗患者肺同期面积减少，引发通气障碍，进而导致肺不张、肺炎等情况，造成机体重要脏器不可逆损害，对患者生命质量造成威胁[2]。目前临床治疗多以支持治疗为主，包括抗感染、机械通气、维持呼吸道通畅，镇静、镇痛、营养支持等。但临床实践发现仅对患者进行常规治疗，其症状改善效果不理想，有学者提出在治疗时加用乌司他丁，能有效缓解急性支气管痉挛，抑制心肌抑制因子产生，改善患者间质性水肿、出血情况[3-4]。本文观察2015年9月-2017年5月期间32例重型创伤性湿肺者，在常规支持治疗基础上使用乌司他丁，患者疾病治疗效果以及呼吸动力学恢复情况，现报道如下。, http://www.100md.com(杨根)
, http://www.100md.com
【关键词】 疗效； 乌司他丁； 创伤性湿肺； 重型
Clinical Observation of Ulinastatin in the Severe Traumatic Wet Lung/YANG Gen.//Medical Innovation of China，2018，15(01)：010-013
【Abstract】 Objective：To explore the clinical effect of Ulinastatin in the respiration ventilation for patients with severe traumatic wet lung.Method：64 patients with severe traumatic wet lung treated from September 2015 to May 2017 in our hospital were selected.The subjects were randomly divided into two groups，32 cases in each group.The control group received the conventional therapy and protective ventilation，the observation group also took Ulinastatin.Before and after treatment，the oxygen dynamic index (PaO2，PaCO2，PaO2/FiO2) and pneodynamics index (RR，Mpaw，PIP) of two groups were compared；the ICU duration time，pulmonary contusion，usage amount of analgesia and sedative agents and weaning time of two groups were observed.Result：The total effective rate in observation group was 93.8% higher than control group of 81.3%，the difference was statistically significant(P<0.05).Upon admission to hospital，the clinical indexes of RR， PaO2/FiO2，PaO2，Mpaw，PIP and PaCO2 of two groups were not significantly different(P>0.05)；after treatment，the above index for observation group were better than control group(P<0.05).The weaning time， ICU duration time and usage amount of analgesia and sedative agents and pulmonary contusion in observation group were better than control group (P<0.05).Conclusion：For patients with severe traumatic wet lung，the conventional therapy and Ulinastatin can improve the clinical effect，promote the recovery of oxygen dynamics and pneodynamics，reduce the pulmonary contusion.
, 百拇医药
【Key words】 Clinical effect； Ulinastatin； Traumatic wet lung； Severe
First-author’s address：Lianjiang People’s Hospital，Lianjiang 524400，China
doi：10.3969/j.issn.1674-4985.2018.01.003
重型創伤性湿肺为患者胸部开放性或闭合性创伤造成肺组织充血、水肿、出血，表面活性物质缺失，通气与血流比例失衡所致[1]。患者临床表现为药物无法纠正的低氧血症以及急性呼吸窘迫综合征，若不及时治疗患者肺同期面积减少，引发通气障碍，进而导致肺不张、肺炎等情况，造成机体重要脏器不可逆损害，对患者生命质量造成威胁[2]。目前临床治疗多以支持治疗为主，包括抗感染、机械通气、维持呼吸道通畅，镇静、镇痛、营养支持等。但临床实践发现仅对患者进行常规治疗，其症状改善效果不理想，有学者提出在治疗时加用乌司他丁，能有效缓解急性支气管痉挛，抑制心肌抑制因子产生，改善患者间质性水肿、出血情况[3-4]。本文观察2015年9月-2017年5月期间32例重型创伤性湿肺者，在常规支持治疗基础上使用乌司他丁，患者疾病治疗效果以及呼吸动力学恢复情况，现报道如下。, http://www.100md.com(杨根)