早期应用乌司他丁联合糖皮质激素治疗严重急性呼吸综合征的临床疗效及对患者预后的影响

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英文篇名：Clinical Effect of Early Use of Ulinastatin Combined with Glucocorticoid on Severe Acute Respiratory Syndrome and the Impact on Prognosis 作者：李虎年 ; 何婷 英文作者：LI Hu-nian;HE Ting;Department of Critical Care Medicine,the People' s Hospital Affiliated to Hubei Medical College;Department of Neurology, the People' s Hospital Affiliated to Hubei Medical College; 关键词：严重急性呼吸综合征 ; 乌司他丁 ; 糖皮质激素类 ; S100蛋白质类 ; 炎症趋化因子 英文关键词：Severe acute respiratory syndrome;;Ulinastatin;;Glucocorticoids;;S100 proteins;;Chemokines 中文刊名：SYXL 英文刊名：Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease 机构：湖北医药学院附属人民医院危重病医学科;湖北医药学院附属人民医院神经内科; 出版日期：2016-10-25 出版单位：实用心脑肺血管病杂志 年：2016 期：v.24 语种：中文; 页：SYXL201610037 页数：4 CN：10 ISSN：13-1258/R 分类号：122-125

摘要

目的探讨早期应用乌司他丁联合糖皮质激素治疗严重急性呼吸综合征(SARS)的临床疗效及对患者预后的影响。方法选取湖北医药学院附属人民医院2014年1月—2016年1月收治的SARS患者78例,按照随机数字表法分为对照组和观察组,每组39例。两组患者入院后均给予基础治疗,对照组患者给予甲泼尼龙治疗,观察组患者在对照组基础上联合乌司他丁治疗;两组患者均持续治疗5 d。比较两组患者临床疗效,治疗前后呼吸频率(RR)、血气分析指标〔动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、氧合指数及p H值〕及血清S100蛋白(S100A8蛋白、S100A9蛋白)、炎性因子〔C反应蛋白(CRP)、白介素6(IL-6)、白介素8(IL-8)、肿瘤坏死因子α(TNF-α)〕水平,并比较两组患者不良反应发生率及28 d病死率。结果观察组患者临床疗效优于对照组(P<0.05)。治疗前,两组患者RR、Pa O2、Pa CO2、氧合指数及p H值比较,差异无统计学意义(P>0.05);治疗后,观察组患者RR、Pa CO2、p H值低于对照组,Pa O2、氧合指数高于对照组(P<0.05)。治疗前,两组患者血清S100A8蛋白、S100A9蛋白水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者血清S100A8蛋白、S100A9蛋白水平低于对照组(P<0.05)。治疗前,两组患者血清CRP、IL-6、IL-8、TNF-α水平比较,差异无统计学意义(P>0.05);治疗后,观察组患者血清CRP、IL-6、IL-8、TNF-α水平低于对照组(P<0.05)。观察组患者不良反应发生率、28 d病死率低于对照组(P<0.05)。结论早期应用乌司他丁联合糖皮质激素治疗SARS的临床疗效确切,可有效改善患者血气分析指标及预后,降低血清S100蛋白及炎性因子水平,且安全性较高。
        Objective To investigate the clinical effect of early use of ulinastatin combined with glucocorticoid on severe acute respiratory syndrome( SARS) and the impact on prognosis. Methods A total of 78 patients with SARS were selected in the People's Hospital Affiliated to Hubei Medical College from January 2014 to January 2016,and they were randomly divided into control group and observation group,each of 39 cases. Patients of the two groups received basic treatment after admission,meanwhile patients of control group received methylprednisolone, while patients of observation group received ulinastatin combined with methylprednisolone; both groups continuously treated for 5 days. Clinical effect, respiratory rate( RR),blood- gas analysis index( including Pa O2,Pa CO2,oxygenation index and p H),serum levels of S100 proteins( including S100A8 protein and S100A9 protein) and inflammatory cytokines( including CRP,IL-6,IL-8 and TNF-α) before and after treatment,incidence of adverse reactions and 28- day fatality rate were compared between the two groups. Results The clinical effect of observation group was statistically significantly better than that of control group( P < 0. 05). No statistically significant differences of RR,Pa O2,Pa CO2,oxygenation index or p H was found between the two groups before treatment( P >0. 05); after treatment,RR, Pa CO2 and p H of observation group were statistically significantly lower than those of control group,while Pa O2 and oxygenation index of observation group were statistically significantly higher than those of control group( P< 0. 05). No statistically significant differences of serum level of S100A8 protein or S100A9 protein was found between the two groups before treatment( P > 0. 05), while serum levels of S100A8 protein and S100A9 protein of observation group were statistically significantly lower than those of control group after treatment( P < 0. 05). No statistically significant differences of serum level of CRP,IL-6,IL-8 or TNF-α was found between the two groups before treatment( P > 0. 05),while serum levels of CRP,IL-6,IL-8 and TNF-α of observation group were statistically significantly higher than those of control group after treatment( P < 0. 05). The incidence of adverse reactions and 28- day fatality rate of observation group was statistically significantly lower than that of control group,respectively( P < 0. 05). Conclusion Early use of ulinastatin combined with glucocorticoid has certain clinical effect in treating SARS,can effectively improve the blood- gas analysis index and prognosis,reduce the S100 protein and serum inflammatory cytokines levels,with relatively high safety.

引文

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