大剂量乌司他丁对急性呼吸窘迫综合征患者呼吸力学和氧化应激的影响

摘要

Objective To investigate the effect of large dose of ulinastatin on respiratory mechanics and oxi-dative stress in patients with acute respiratory distress syndrome(ARDS).Methods 54 patients with ARDS in our hospital from Jan.2011 to Aug.2013 were randomly divided into observation group and control group, with 27 cases in each group.The control group was treated with conventional therapy.The observation group was treated with large dose of ulinastatin on basis of conventional treatment, the changes of respiratory mechanics indexes and oxidative stress parameters before and after treatment between the two groups were compared.Results The positive end expira-tory pressure( PEEP) in the control group was significantly lower than that before treatment, the static lung compli-ance was significantly higher than that before treatment(P<0.05);the inspiratory resistance and PEEP in the obser-vation group were significantly lower than those before treatment(P<0.05), the static lung compliance was signifi-cantly higher than that before treatment(P<0.05).After treatment, the inspiratory resistance and PEEP in the ob-servation group were significantly lower than those in the control group(P<0.05), the static lung compliance was significantly higher than that in the control group(P<0.05).Malondialdehyde in the control group was significantly lower than that before treatment(P<0.05), superoxide dismutase was significantly higher than that before treatment (P<0.05);malondialdehyde in the observation group was significantly lower than that before treatment(P<0.05), superoxide dismutase, glutathione and total oxidative capacity were significantly higher than those before treatment ( P<0.05).After treatment, malondialdehyde in the observation group was significantly lower than that in the control group, superoxide dismutase, glutathione and total oxidative capacity were significantly higher than those in the con-trol group( all P<0.05) .Conclusion Large dose of ulinastatin intravenous injection can effectively improve respira-tory mechanics and oxidative stress of patients with ARDS, reduce lung injury, improve pulmonary ventilation func-tion and play a positive role in improving prognosis of patients with ARDS.%目的：探讨大剂量乌司他丁对急性呼吸窘迫综合征（ ARDS）患者呼吸力学和氧化应激的影响。方法选择2011-01～2013-08收治的ARDS患者54例，随机分为观察组和对照组各27例。对照组采用常规的治疗措施，观察组在常规治疗基础上应用大剂量乌司他丁治疗，比较两组患者治疗前后的呼吸力学指标和氧化应激指标的变化情况。结果治疗后，对照组呼气末正压（PEEPi）明显低于治疗前（P＜0.05），肺静态顺应性（Cs）明显高于治疗前（P＜0.05）；观察组治疗后吸气阻力（Ri）、PEEPi明显低于治疗前和对照组（P＜0.05），Cs明显高于治疗前和对照组（P＜0.05）。治疗后，对照组丙二醛（MDA）明显低于治疗前（P＜0.05），超氧化物歧化酶（SOD）明显高于治疗前（P＜0.05）；观察组治疗后MDA 明显低于治疗前和对照组（P＜0.05），SOD、谷胱甘肽（GSH）、总氧化能力（TAO）明显高于治疗前和对照组（P＜0.05）。结论大剂量乌司他丁静脉滴注后能有效地改善ARDS患者呼吸力学和氧化应激状态，减少肺损伤，提高肺通气功能，对改善ARDS患者预后有着积极的作用。