依达拉奉联合乌司他丁对创伤性湿肺患者氧代谢、炎性反应及氧化应激的影响
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摘要
目的观察依达拉奉联合乌司他丁对创伤性湿肺患者氧代谢、炎性反应及氧化应激的影响。方法 100例创伤性湿肺患者随机分为对照组和观察组,每组50例。对照组在基础治疗和呼吸支持的基础上加用乌司他丁(30万U,静脉滴注, bid),观察组在对照组治疗的基础上加用依达拉奉(30 mg,静脉滴注,bid),连用14 d。比较两组患者治疗前后急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、氧代谢指标[呼吸频率(RR)、动脉血氧分压(PaO_2)、氧合指数(PaO_2/FiO_2)、动脉血氧饱和度(SaO_2)和血乳酸(Lac)]、炎性因子[C反应蛋白(CRP)、白细胞介素-6 (IL-6)、肿瘤坏死因子-α(TNF-α)]及氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)、表面活性物质相关蛋白D (SP-D)]的变化,记录两组患者药物不良反应、病情演变及预后状况。结果治疗14 d后,两组患者的APACHEⅡ评分及氧代谢指标(RR、 PaO_2、 PaO_2/FiO_2、 SaO_2、 Lac)、炎性因子(CRP、 IL-6、 TNF-α)水平、氧化应激指标(MDA、 SP-D)均较治疗前明显改善(均P <0.01),而观察组患者改善更显著(P <0.01)。两组SOD水平均有下降,但观察组SOD水平显著高于对照组(P <0.01)。观察组患者的肺挫伤程度、脱机时间、 ICU住院时间及肺实变率均优于对照组(P <0.01或P <0.05)。两组患者的药物不良反应发生率差异无显著意义(P> 0.05)。结论依达拉奉联合乌司他丁治疗创伤性湿肺,可有效改善患者氧代谢、炎性反应和氧化应激水平,疗效优于乌司他丁单用,安全性好。
AIM To observe the effects of edaravone combined with ulinastatin on oxygen metabolism,inflammatory response and oxidative stress in patients with traumatic wet lung( TWL). METHODS One hundred patients with TWL were randomly divided into control group(n = 50) and observation group(n = 50).The control group was given ulinastatin(300 000 U, intravenous drip, bid) on the basis of basic treatment and respiratory support, and the observation group was treated with edaravone(30 mg, intravenous drip, bid) on the basis of the treatment in the control group, continuous use for 14 days. Changes of acute physiology and chronic health evaluation Ⅱ( APACHE Ⅱ) score, oxygen metabolism index( respiratory rate( RR), arterial partial pressure of oxygen( PaO_2), oxygen index( PaO_2/FiO_2), arterial oxygen saturation( SaO_2) and blood lactic acid(Lac)), inflammation index(C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α( TNF-α)), and oxidative stress index( malondialdehyde( MDA), superoxide dismutase( SOD),surface active substance associated protein(SP-D)) levels of patients in two groups were compared before and after treatment. The adverse drug reactions, disease progression and prognosis of two groups were recorded.RESULTS Compared with those before the treatment, APACHE Ⅱ score, and the oxygen metabolism index( RR, PaO_2, PaO_2/FiO_2, SaO_2, Lac), inflammation index( CRP, IL-6, TNF-α), oxidative stress index(MDA, SP-D) improved significantly after 14 days of treatment(all P < 0.01) in two groups, and those in the observation group improved more significantly(P < 0.01). The levels of SOD decreased in two groups, but the SOD level in the observation group was significantly higher than that in the control group(P < 0.01). The degree of pulmonary contusion, off-line time, ICU hospitalization time and lung consolidation rate in the observation group were better than those in the control group(P < 0.01 or P < 0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups( P > 0.05). CONCLUSION Edaravone combined with ulinastatin in treating TWL can improve the levels of oxygen metabolism, inflammation response and oxidative stress, has better curative effect compared with ulinastatin alone and has good safe.
AIM To observe the effects of edaravone combined with ulinastatin on oxygen metabolism,inflammatory response and oxidative stress in patients with traumatic wet lung( TWL). METHODS One hundred patients with TWL were randomly divided into control group(n = 50) and observation group(n = 50).The control group was given ulinastatin(300 000 U, intravenous drip, bid) on the basis of basic treatment and respiratory support, and the observation group was treated with edaravone(30 mg, intravenous drip, bid) on the basis of the treatment in the control group, continuous use for 14 days. Changes of acute physiology and chronic health evaluation Ⅱ( APACHE Ⅱ) score, oxygen metabolism index( respiratory rate( RR), arterial partial pressure of oxygen( PaO_2), oxygen index( PaO_2/FiO_2), arterial oxygen saturation( SaO_2) and blood lactic acid(Lac)), inflammation index(C-reactive protein(CRP), interleukin-6(IL-6), tumor necrosis factor-α( TNF-α)), and oxidative stress index( malondialdehyde( MDA), superoxide dismutase( SOD),surface active substance associated protein(SP-D)) levels of patients in two groups were compared before and after treatment. The adverse drug reactions, disease progression and prognosis of two groups were recorded.RESULTS Compared with those before the treatment, APACHE Ⅱ score, and the oxygen metabolism index( RR, PaO_2, PaO_2/FiO_2, SaO_2, Lac), inflammation index( CRP, IL-6, TNF-α), oxidative stress index(MDA, SP-D) improved significantly after 14 days of treatment(all P < 0.01) in two groups, and those in the observation group improved more significantly(P < 0.01). The levels of SOD decreased in two groups, but the SOD level in the observation group was significantly higher than that in the control group(P < 0.01). The degree of pulmonary contusion, off-line time, ICU hospitalization time and lung consolidation rate in the observation group were better than those in the control group(P < 0.01 or P < 0.05). There was no significant difference in the incidence of adverse drug reactions between the two groups( P > 0.05). CONCLUSION Edaravone combined with ulinastatin in treating TWL can improve the levels of oxygen metabolism, inflammation response and oxidative stress, has better curative effect compared with ulinastatin alone and has good safe.
引文
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[2]蒋勇,王康安,朱邦晖.微小RNA对急性肺损伤或急性呼吸窘迫综合征病理作用的研究进展[J].中华重症医学电子杂志,2018,4(1):69-74.
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[9]王园园,薄禄龙,邓小明.创伤性脑损伤后肺损伤的发病机制研究进展[J].国际麻醉学与复苏杂志,2017,38(11):1045-1048.
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[11]王向蒙,肖文凯,邓烈华.中性粒细胞来源微颗粒引起大鼠急性呼吸窘迫综合征的病理学变化[J].中国急救医学,2018,38(1):89-93.
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[13]郭强,唐颖,闫百灵,等.C反应蛋白在慢性阻塞性肺疾病中的研究进展[J].中国老年学杂志,2017,37(3):753-755.
[14]江伟航,王琳,阮绪广,等.内毒素致大鼠急性肺损伤后蛋白酶激活受体-1、肿瘤坏死因子-α和白细胞介素-6的表达[J].广东医学,2016,37(8):1143-1146.
[15]黄丛富,郝雪琴,邓雯,等.咪达普利对氯化铵所致急性肺损伤大鼠血气、MDA及AngⅡ、CD54蛋白表达的影响[J].中国病理生理杂志,2016,32(2):278-283.
[16]李峰,田冰锋,魏小兵,等.重型颅脑创伤急性期和慢性期外周血炎症反应标志物和氧化应激临床研究[J].中国现代神经疾病杂志,2018,18(2):128-133.
[17]刘学芳,冯素香,田燕歌,等.肺泡表面活性物质与慢性阻塞性肺疾病研究进展[J].中国老年学杂志,2018,38(6):1521-1523.
[18]MADAN T.Recombinant fragment of human surfactant protein D:a hierarchical regulator of pulmonary hypersensitivity[J].Am J Respir Crit Care Med,2017,196(12):1495-1496.
[19]闫战秋,帅训军,艾登斌,等.依达拉奉抗单肺通气患者炎性反应时的p38丝裂原活化蛋白激酶表达[J].中国新药与临床杂志,2015,34(4):293-296.
[20]陈未平,房晓薇,吴利东.依达拉奉联合乌司他丁对急性百草枯中毒大鼠肺损伤的保护作用[J].南昌大学学报:医学版,2016,56(4):13-15.
[21]王合金,朱平先,李惠.依达拉奉联合乌司他丁对急性肺损伤患者的影响研究[J].实用心脑肺血管病杂志,2012,20(6):974-976.
[22]刘月英,郭宪民,李波,等.依达拉奉对急性肺损伤大鼠肺组织凋亡的影响[J].中国老年学杂志,2017,37(18):4482-4484.
[23]温秀梅.依达拉奉联合托拉塞米对急性脑出血患者氧化应激、炎症因子、微循环及血液流变学的影响[J].中华全科医学,2017,15(10):1704-1706.
[24]冯鑫.依达拉奉对COPD大鼠氧化应激及肺泡上皮细胞凋亡的影响[D].泸州:西南医科大学,2016:1-61.
[25]WANG X,LAI R,SU X,et al.Edaravone attenuates lipopolysaccharide-induced acute respiratory distress syndrome associated early pulmonary fibrosis via amelioration of oxidative stress and transforming growth factor-β1/Smad3 signaling[J].Biochem Biophys Res Commun,2018,495(1):706-712.
[2]蒋勇,王康安,朱邦晖.微小RNA对急性肺损伤或急性呼吸窘迫综合征病理作用的研究进展[J].中华重症医学电子杂志,2018,4(1):69-74.
[3]杨根.乌司他丁治疗重型创伤性湿肺的临床观察体会[J].中国医学创新,2018,15(1):10-13.
[4]周桥灵,赵伟成,廖美娟,等.不同剂量右美托咪定联合乌司他丁对肺叶切除术患者肺损伤的保护作用[J].实用医学杂志,2018,34(2):281-284.
[5]邵悦萍,高建波.乌司他丁治疗重型颅脑损伤后急性肺损伤的疗效观察[J].中国现代应用药学,2015,32(5):612-616.
[6]肖飞,孙杰,魏宜,等.依达拉奉治疗创伤性湿肺患者的临床观察[J].汕头大学医学院学报,2014,27(4):227-238.
[7]中华医学会重症医学分会.急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006)[J].中国危重病急救医学,2007,46(5):430-435.
[8]曹娟.高频振荡通气治疗常频机械通气失败的新生儿持续肺动脉高压的效果[J].广东医学,2015,36(2):230-232.
[9]王园园,薄禄龙,邓小明.创伤性脑损伤后肺损伤的发病机制研究进展[J].国际麻醉学与复苏杂志,2017,38(11):1045-1048.
[10]RAJAGOPAL R,GANESH S,VETRIVEL M.Neurogenic pulmonary edema in traumatic brain injury[J].Indian J Crit Care Med,2017,21(5):329-331.
[11]王向蒙,肖文凯,邓烈华.中性粒细胞来源微颗粒引起大鼠急性呼吸窘迫综合征的病理学变化[J].中国急救医学,2018,38(1):89-93.
[12]HAN CH,GUAN ZB,ZHANG PX,et al.Oxidative stress induced necroptosis activation is involved in the pathogenesis of hyperoxic acute lung injury[J].Biochem Biophys Res Commun,2018,495(3):2178-2183.
[13]郭强,唐颖,闫百灵,等.C反应蛋白在慢性阻塞性肺疾病中的研究进展[J].中国老年学杂志,2017,37(3):753-755.
[14]江伟航,王琳,阮绪广,等.内毒素致大鼠急性肺损伤后蛋白酶激活受体-1、肿瘤坏死因子-α和白细胞介素-6的表达[J].广东医学,2016,37(8):1143-1146.
[15]黄丛富,郝雪琴,邓雯,等.咪达普利对氯化铵所致急性肺损伤大鼠血气、MDA及AngⅡ、CD54蛋白表达的影响[J].中国病理生理杂志,2016,32(2):278-283.
[16]李峰,田冰锋,魏小兵,等.重型颅脑创伤急性期和慢性期外周血炎症反应标志物和氧化应激临床研究[J].中国现代神经疾病杂志,2018,18(2):128-133.
[17]刘学芳,冯素香,田燕歌,等.肺泡表面活性物质与慢性阻塞性肺疾病研究进展[J].中国老年学杂志,2018,38(6):1521-1523.
[18]MADAN T.Recombinant fragment of human surfactant protein D:a hierarchical regulator of pulmonary hypersensitivity[J].Am J Respir Crit Care Med,2017,196(12):1495-1496.
[19]闫战秋,帅训军,艾登斌,等.依达拉奉抗单肺通气患者炎性反应时的p38丝裂原活化蛋白激酶表达[J].中国新药与临床杂志,2015,34(4):293-296.
[20]陈未平,房晓薇,吴利东.依达拉奉联合乌司他丁对急性百草枯中毒大鼠肺损伤的保护作用[J].南昌大学学报:医学版,2016,56(4):13-15.
[21]王合金,朱平先,李惠.依达拉奉联合乌司他丁对急性肺损伤患者的影响研究[J].实用心脑肺血管病杂志,2012,20(6):974-976.
[22]刘月英,郭宪民,李波,等.依达拉奉对急性肺损伤大鼠肺组织凋亡的影响[J].中国老年学杂志,2017,37(18):4482-4484.
[23]温秀梅.依达拉奉联合托拉塞米对急性脑出血患者氧化应激、炎症因子、微循环及血液流变学的影响[J].中华全科医学,2017,15(10):1704-1706.
[24]冯鑫.依达拉奉对COPD大鼠氧化应激及肺泡上皮细胞凋亡的影响[D].泸州:西南医科大学,2016:1-61.
[25]WANG X,LAI R,SU X,et al.Edaravone attenuates lipopolysaccharide-induced acute respiratory distress syndrome associated early pulmonary fibrosis via amelioration of oxidative stress and transforming growth factor-β1/Smad3 signaling[J].Biochem Biophys Res Commun,2018,495(1):706-712.
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