摘要
目的探讨乌司他丁(Ulinastatin)联合血必净治疗对重症肺炎患者心肌损伤的保护作用。方法将118例合并心肌损伤的重症肺炎患者随机分为对照组(59例)和观察组(59例),对照组在常规治疗(抗感染、液体复苏、改善循环及营养支持等)的基础上给予乌司他丁(Ulinastatin,90万U/d,连用2周)加强抗炎治疗;观察组在对照组治疗基础上加用血必净(100mL/d,连用2周)。观察两组患者治疗前后的急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、肌钙蛋白I(cTnI)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、脑利钠肽(BNP)、肌酸激酶同工酶(CK-MB)和乳酸脱氢酶(LDH)等指标的变化。结果两组患者治疗前的APACHEⅡ评分、cTnI、TNF-α、IL-6、BNP、CK-MB和LDH水平差异无统计学意义(P>0.05);治疗2周后,观察组较对照组APACHEⅡ评分(分:10.02±2.13vs.21.32±4.67)、cTnI(μg/L:1.03±0.03vs.1.96±0.02)、TNF-a(μg/mL:21.01±6.97 vs.34.38±6.83)、IL-6(μg/mL:220.82±68.69vs.375.28±68.69)、BNP(μg/L:355.8±135.79 vs.727.40±445.13)、CK-MB(U/L:93.30±25.50vs.155.20±33.20)、LDH(U/L:342.20±48.30 vs.522.30±26.80)水平均显著下降,差异有统计学意义(P<0.01)。结论在常规治疗基础上加用乌司他丁联合血必净,能降低重症肺炎患者血TNF-α、IL-6水平,减轻重症肺炎合并的心肌损伤。
Objective To investigate the protective effect of myocardial injury with Ulinastatin and Xuebijing in treatment of patients with severe pneumonia.Methods One hundred and eighteen patients with severe pneumonia and myocardial injury were divided into the comparison group and the test group,each of fifty-nine patients.All patients were treated by anti-infection,fluid resuscitation,improvement of circulation and nutrition support.The comparison group was treated by ulinastatin 900,000 U ivd,qd,for two weeks.The test group was treated by ulinastatin 900,000 U ivd and Xuebijing 100 mL,ivd,qd,for two weeks.It's detected the change of APACHEⅡscore,cardiac troponin I(cTnI),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),brain natriuretic peptide(BNP),creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)and other indicators of the two groups before and after treatment.Results The indicators of the APACHEⅡscore,blood cTnI,TNF-α,IL-6,BNP,CK-MB,LDH of the two groups before treatment had no significant(P>0.05).The indicators of the APACHEⅡscore(after treatment,the comparison group was 21.32±4.67,and the test group is 10.02±2.13),serum cInI(μg/L:after treatment,the comparison group was 1.96±0.02,and the test group was 1.03±0.03),TNF-α(μg/mL,after treatment,the comparison group is 34.38±6.83,and the test group is 21.01±6.97),IL-6(μg/mL,after treatment,the comparison group was 375.28±68.69,and the test group was 220.82±68.69),BNP(μg/L,after treatment,the comparison group was 727.40±445.13,and the test group was 355.80±135.79),CK-MB(U/L,after treatment,the comparison group was 155.20±33.20,and the test group was 93.30±25.50),LDH(U/L,after treatment,the comparison group was 522.30±26.80,and the test group was 342.20±48.30)levels of the test group were significantly decrease than the same indicators of the comparison group after treatment(P<0.01).Conclusion We could add with Ulinastatin and Xuebijing to the common therapy to improve the effect to treat the severe pneumonia with myocardial injury,and reduce the TNF-α,IL-6 levels of the patients with severe pneumonia and myocardial injury,and reduce the myocardial injury of the patients with severe pneumonia.
作者
严首春
Yan Shou-chun(Shanci University of Chinese Medicine,Xi xian New Area 712046 China)
出处
《中国急救医学》
CAS
CSCD
北大核心
2019年第5期462-466,共5页
Chinese Journal of Critical Care Medicine
关键词
乌司他丁
血必净
重症肺炎
心肌损伤
Ulinastatin
Xuebijing
Severe pneumonia
Myocardial injury
