血必净与乌司他丁配伍治疗重症肺炎237例

摘要

目的:探讨血必净与乌司他丁配伍治疗重症肺炎的临床疗效.方法:将237例重症肺炎患者随机分为对照组、血必净组、乌司他丁组及血必净+乌司他丁联合治疗组,并于治疗前、治疗后1周、2周分别测定纤支镜肺灌洗液中蛋白含量/血浆蛋白、中性粒细胞数目(N)及炎症因子IL-6浓度,监测血气分析氧分压、肺泡-动脉氧分压差,测定肺顺应性变化,评估肺功能恢复情况.结果:四组患者治疗两周后纤支镜肺灌洗液中IL-6分别为159.3±11.4 ng/L,143.1±9.9 ng/L,139.1±7.8 ng/L,125.7±11.8ng/L;中性粒细胞数目分别为9.4±0.9,8.9±0.8,8.3±0.5,7.9±0.8;白蛋白含量/血浆白蛋白分别为0.72±0.06,0.66±0.05,0.59±0.03,0.51±0.06;肺顺应性分别为199.89±12.79,203.99±12.88,205.87±11.97,213.85±11.19;血气分析氧分压分别为105.3±14.5,101.3±5.7,107.9±4.9,115.3±11.9;肺泡-动脉氧分压差分别为13.8±3.1,15.3±3.5,13.1±4.7,10.1±1.9.四组患者组内相比,肺灌洗液中IL-6,中性粒细胞、白蛋白含量/血浆白蛋白、肺泡-动脉氧分压差均显著下降(P＜0.05),肺顺应性、血氧分压均明显升高(P＜0.05).提示肺功能明显改善,但以联合治疗组效果最好(P＜0.05).结论:血必净联合乌司他丁治疗重症肺炎,能够强效抗感染、改善机体氧和、降低毛细血管通透性.%Objective : To observe the clinical therapeutic efficiency of Xuebijing injection and Ulinastatin on severe pneumonia treatment. Methods :237 cases were randomized into control group , Xuebijing group, Ulinastatin group, Xuebijing and Ulinastatin combination group .It's detected the protein content/ plasma proteins of bron-choalveolar lavage fluid (BALF) ,neutrophils numbers and inflammatory factor IL-6 concentration ,also monitored PaO2 and P(A-a)O2 of blood gas analysis , pulmonary compliance changes by end-tidal airway occlusion technique before and after 1,2 weeks in the experiment ,for the lung function recoverd evaluation .Results : Four groups of patients bronchoscopy lung lavage fluid IL-6 after 2 weeks of treatment were 159 .3±11 .4 ng / L, 143 ,1 i 9 ,9 ng/L , 139 .1 ± 7 .8ng/L , 125 .7±11 .8ng/L , neutral Granular cell numbers were 9 .4±0 .9 ,8 .9 ± 0 .8 ,8 .3 ± 0 .5 ,7 .9 ± 0 . 8 , albumin concentration / serum albumin were 0 .72±0 .06 , 0 .66±0 .05 , 0 .59 ± 0 .03 ,0 .51 ± 0 .06 , lung compli-anceas 199 .89±12 .79 ,203 .99±12 .88 ,205 .87±11 .97 ,213 .85±11 .19 , blood gas analysis of oxygen partial pressure were 105 .3 ± 14 .5 ,101.3±5 .7 ,107 .9±4 .9 ,115 .3±11 .9 , alveolar - arterial oxygen difference were 13 .8±3 . 1,15 .3±3 .5 , 13 .1±4 .7 , 10 .1 ± 1 .9 .Four groups of patients was compared in lung lavage fluid IL-6 , neutrophil cells , albumin concentration / serum albumin, alveolar - arterial oxygen difference were significantly decreased (P <0.05) , lung compliance ,blood oxygen partial pressure were significantly higher (P <0 .05) , and prompted lung function improved significantly , but the best effect to the combination therapy group .Conclusion : The combination group is more effective in the treatment of severe pneumonia ,and the causes are relevant to potent anti-infection ,the body oxygen improvement and capillary permeability reduction .