乌司他丁联合血必净及抗结核药物对肺结核患者合并急性呼吸窘迫综合征动脉血气及乳酸清除率的影响

摘要

Objective:To investigate the effects of ulinastatin combined with Xuebijing and anti tubercu-losis drugs on arterial blood gas and lactate clearance in patients with pulmonary tuberculosis complicated with acute respiratory distress syndrome . Methods: 60 pulmonary tuberculosis patients with acute respiratory dis-tress syndrome in our hospital were selected and randomly divided into the control group and the experiment group with 30 cases in each group.Patients in control group were treated with antituberculosis drugs and xuebi-jing;the experiment group was treated with Ulinastatin Injection on the basis of the control group. After treat-ment,the clinical efficacy,arterial blood gas,inflammatory factors ( IL-1,CPR,TNF-α,PCT) and blood lactate clearance rate of two groups were compared. Results:The effective rate of the treatment group was 93. 33%, which was higher than that of the control group 73.33% ( P <0.05) ;Compared with before treatment,the PaO2,blood lactate clearance rate increased,the PaCO2 decreased after treatment( P < 0.05);Comparedwith the control group,the PaO2,blood lactate clearance rate was higher,the PaCO2 level was lower ( P <0. 05);After treatment,the serum levels of IL-1, CPR, TNF-α and PCT were controlled in the two groups,and the levels of serum IL-1,CPR,TNF-and PCT in the experiment group were lower than those in the con-trol group ( P < 0.05) . Conclusion:The combined application of ulinastatin Injection and xuebijing and anti-tuberculosis drugs can effectively improve pulmonary tuberculosis complicated with acute respiratory distress syndrome in patients with the effective rate of treatment. It can improve the respiratory circulation,promote the recovery of pulmonary function, arterial oxygen content adjustment, the mechanism might be related to lung function,improve blood gas levels,improve blood lactate clearance rate increased and decreased inflammatory factor IL-1,CPR,TNF- alpha,PCT concentration.%目的:探讨乌司他丁、血必净与抗结核药物的联合应用对肺结核合并急性呼吸窘迫综合征患者动脉血气及乳酸清除率的影响.方法:选取前来我院急诊的肺结核合并急性呼吸窘迫综合征患者共计60例,随机分为对照组和治疗组,每组30例.对照组给与患者抗结核药物及血必净进行联合对症治疗;治疗组在对照组基础上加入乌司他丁注射液进行治疗.治疗结束后对比两组患者临床有效率、动脉血气、炎性因子(IL-1、CPR、TNF-α、PCT)、血乳酸清除率的变化情况.结果:治疗组有效率为93.33%,高于对照组73.33%的有效率,差异具有统计学意义(P<0.05);与治疗前比较,治疗后患者PaO2、血乳酸清除率升高,PaCO2降低,差异具有统计学意义(P<0.05);与对照组相比,治疗组患者PaO2、血乳酸清除率较高,PaCO2水平较低,差异具有统计学意义(P<0.05);治疗后,两组患者血清IL-1、CPR、TNF-α、PCT水平得到控制,且治疗组血清IL-1、CPR、TNF-α、PCT水平低于对照组,差异具有统计学意义(P<0.05).结论:乌司他丁注射液与血必净及抗结核药物的联合应用可有效提高肺结核合并急性呼吸窘迫综合征患者的治疗有效率,改善呼吸循环,促进肺功能恢复,调整动脉血氧含量,推测其机制可能与肺功能的提升、血气水平的改善、血乳酸清除率增加及炎性因子IL-1、CPR、TNF-α、PCT浓度的降低有关.