乌司他丁联合生脉注射液在老年急腹症患者围手术期的应用

摘要

目的 探讨乌司他丁联合生脉注射液在老年急腹症患者围术期治疗中的作用.方法 老年急腹症急诊手术患者48例,按随机数字表法分为3组,术前(T0)及术后3天(T2)常规治疗组(Ⅰ组)给予等量生理盐水静脉注射,乌司他丁组(Ⅱ组)给予乌司他丁静脉注射,乌司他丁联合生脉注射液组(Ⅲ组)给予乌司他丁联合生脉注射液静脉注射.术前(T0)及术后1天(T1)、3天(T2)、7天(T3)静脉采血测定白介素6(IL6)、肿瘤坏死因子-α(TNF-α)、丙氨酸转氨酶(ALT)、血清尿素氮(BUN)、血清肌酐(Cr)及肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnI),并进行血管活性药物使用率、休克发生率、多器官功能障碍综合征(MODS)发生率、死亡率、ICU治疗时间、住院时间比较.结果 T1～T3时Ⅱ组及Ⅲ组IL6、TNF-α浓度较Ⅰ组低(P＜0.05),Ⅲ组浓度最低；术后ALT、BUN、Cr在T1、T2时点以Ⅰ组增高最显著；3组术后CK-MB、cTnI均出现不同程度的增高,而以Ⅲ组升高幅度最低,与Ⅰ组、Ⅱ组比较差异有统计学意义(P＜0.05),T1～ T3时Ⅱ组及Ⅲ组均低于Ⅰ组(P＜0.05)；Ⅱ、Ⅲ组休克发生率及血管活性药物使用率降低,其中Ⅲ组降低最显著,与其他两组比较有统计学意义(P＜0.05)；Ⅱ、Ⅲ组患者住院时间及ICU治疗时间均较Ⅰ组缩短,同时死亡率及MODS发生率降低(P＜0.05).结论 老年急腹症患者围术期应用乌司他丁有助于改善全身炎症反应,保护重要脏器功能,并降低并发症发生率,缩短治疗时间.联合应用生脉注射液可进一步抑制炎症介质释放,保护心肌功能,减少休克发生及血管活性药物使用率.%Objective To evaluate the therapy effect of Ulinastatin and pulse-activating injection in elderly patients with acute abdomen in perioperative period. Methods Forty eight elderly patients with acute abdomen undergoing emergency surgery were randomly divided into 3 groups. Before surgery (To) and 3 days after surgery (T2) , group I received routine treatment with Sodium Chloride m. T. D. ,group II was treated with Ulinastatin I. V,and group IH received Ulinastatin I. V. Combined with pulse-activating injection intravenously. Interleukin-6 (IL-6) ,tumor necrosis factor-alpha (TNF-a) ,alanine transaminase (ALT) ,creatinine (Cr) ,serum urea nitrogen ( SUN) , MB isoenzyme of creatine kinase ( CK-MB ) , cardiac troponin ( cTnl) were measured at TO, and 1 ( T, ) , 3 (T2),7 (T4) days after operation. Meanwhile, usage of vasoactive drugs, incidence of shock, incidence of multiple organ dysfunction syndrome (MODS) ,mortality,ICU treatment time,length of stay were compared among different groups. Results The concentration of IL6 and TNF-a were lower in group II and IH (lowest) than those in group I at T, ,T2 and T3 (P < 0. 05). The concentration of ALT, BUN and Cr at T, and T2 increased obviously in group I . After operation, the concentration of CK-MB and cTnl increased in three groups. The increase in group HI was significantly lower than that in group I and II (P < 0.05). And the increase in group II and IE was significantly lower than that in group I at T, ,T1 and T3( P < 0.05 ) . Incidence of shock and usage of vasoactive drugs in group III decreased significantly compared with those in other two groups (P < 0.05). The length of stay and ICU treatment time in group I[ and HI were shorter than those in group I ,at the same time the incidence of mortality and MODS in group II and W were significantly lower than those in group I (P < 0. 05 ). Conclusions Perioperative application of Ulinastatin can help elderly patients with acute abdomen to improve systemic inflammatory response, protect function of important organs, reduce incidence of complications, and shorten treatment time. The use of pulse-activating injection can further inhibit the release of inflammatory mediators, protect myocardial function, and reduce the incidence of shock and usage of vasoactive drugs.