乌司他丁联合东莨菪碱对急性呼吸窘迫综合征患者炎症因子及免疫功能的影响
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摘要
目的探讨乌司他丁联合东莨菪碱对急性呼吸窘迫综合征(ARDS)患者炎性因子、免疫功能的影响,为临床拟制用药方案提供参考。方法选取98例ARDS患者,将其按随机数字表法分为常规组49例与治疗组49例。常规组予以常规治疗,治疗组在其基础上予以乌司他丁联合东莨菪碱治疗。比较2组炎性因子、T淋巴细胞亚群水平变化,记录2组ICU治疗、机械通气时间及病死率。结果经1周治疗后,治疗组患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞介素-8 (IL-8)、C反应蛋白(CRP)、降钙素原(PCT)以及白细胞计数(WBC)水平均明显低于常规组(P均<0. 05),CD4+、CD4+/CD8+均显著高于常规组(P均<0. 05),而2组治疗前后及2组间CD8+比较差异均无统计学意义(P均> 0. 05);治疗组患者ICU治疗及机械通气时间均明显短于常规组(P均<0. 05);治疗组ICU内病死率比较明显低于常规组(P均<0. 05)。2组不良反应均较为轻微且组间比较差异均无统计学意义(P均> 0. 05)。结论乌司他丁联合东莨胆碱能够有效改善患者的免疫功能,清除炎性因子,降低病死率,缩短治疗时间,具有应用推广价值。
Objective It is to investigate the effects of ulinastatin combined with scopolamine on inflammatory factors and immune function in patients with acute respiratory distress syndrome(ARDS),and to provide reference for clinical preparation of drug regimens. Methods Ninety-eight patients with ARDS were enrolled and divided into conventional group(n = 49) and treatment group(n = 49) according to the random number table method. The conventional group was treated with routine therapy,and the treatment group was treated with ulinastatin and scopolamine based on the conventional group.The changes of the levels of inflammatory factors and T lymphocyte subsets were compared between the two groups. The ICU treatment,mechanical ventilation time and mortality of the two groups were recorded. Results After 1 week of treatment,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),C-reactive protein(CRP),procalcitonin(PCT) and white blood cell count(WBC) in the treatment group were significantly lower while CD4+and CD4+/CD8+were significantly higher than those in the conventional group(P < 0. 05),but there was no significant difference in the level of CD8+before and after treatment and between the two groups(P > 0. 05). ICU treatment and mechanical ventilation time in the treatment group were significantly shorter than that of the conventional group(P < 0. 05). The mortality in the ICU was significantly lower in the treatment group than that in the conventional group(P < 0. 05). The adverse reactions in both groups were mild and the differences between the groups were not significant(P > 0. 05). Conclusion Ulinastatin combined with scutellaria choline can effectively improve the immune function,eliminate inflammatory factors,reduce mortality,shorten treatment time in the patients with ARDS,it is worthy promoting in clinic.
Objective It is to investigate the effects of ulinastatin combined with scopolamine on inflammatory factors and immune function in patients with acute respiratory distress syndrome(ARDS),and to provide reference for clinical preparation of drug regimens. Methods Ninety-eight patients with ARDS were enrolled and divided into conventional group(n = 49) and treatment group(n = 49) according to the random number table method. The conventional group was treated with routine therapy,and the treatment group was treated with ulinastatin and scopolamine based on the conventional group.The changes of the levels of inflammatory factors and T lymphocyte subsets were compared between the two groups. The ICU treatment,mechanical ventilation time and mortality of the two groups were recorded. Results After 1 week of treatment,the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),interleukin-8(IL-8),C-reactive protein(CRP),procalcitonin(PCT) and white blood cell count(WBC) in the treatment group were significantly lower while CD4+and CD4+/CD8+were significantly higher than those in the conventional group(P < 0. 05),but there was no significant difference in the level of CD8+before and after treatment and between the two groups(P > 0. 05). ICU treatment and mechanical ventilation time in the treatment group were significantly shorter than that of the conventional group(P < 0. 05). The mortality in the ICU was significantly lower in the treatment group than that in the conventional group(P < 0. 05). The adverse reactions in both groups were mild and the differences between the groups were not significant(P > 0. 05). Conclusion Ulinastatin combined with scutellaria choline can effectively improve the immune function,eliminate inflammatory factors,reduce mortality,shorten treatment time in the patients with ARDS,it is worthy promoting in clinic.
引文
[1]乔良,刘志.急性呼吸窘迫综合征的诊断标准及早期识别[J].中华急诊医学杂志,2015,24(3):237-240
[2]颜洪顺,王志峰.乌司他丁联合东莨菪碱治疗急性呼吸窘迫综合征疗效观察[J].现代中西医结合杂志,2016,25(11):1220-1240
[3]陈蝶,彭再梅.急性呼吸窘迫综合征生物标志物与生物治疗研究[J].中华急诊医学杂志,2016,25(3):264-267
[4]周娜,李来传,史有奎,等.血必净联合乌司他丁静脉注射对ARDS患者支气管肺泡灌洗液中相关细胞因子的影响[J].山东医药,2015,55(45):71-72
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[6]李亚华,陈刚.甲强龙、低分子肝素对肺脂肪栓塞致急性呼吸窘迫综合征的防治作用的研究[J].中华急诊医学杂志,2016,25(3):310-313
[7]陈晖,王丹,李亚明,等.急性呼吸窘迫综合征患者白介素6及白介素8水平变化研究[J].中国全科医学,2016,19(5):538-541
[8]田昭涛,冯慧远,李慧丽,等.乌司他丁对术后炎症反应和血液高凝状态的影响机制研究[J].中华医院感染学杂志,2014,24(4):853-856
[9]郝建文.急诊呼吸机治疗急性呼吸窘迫综合征86例疗效观察[J].中国基层医药,2013,20(8):1207-1208
[10]刘军.正确理解危重病免疫与炎症的关系[J].中华医学杂志,2017,97(7):483-486
[11]吴永强,赵景成,杨坤,等.无创呼吸机联合乌司他丁对急性呼吸衰竭综合征患者免疫及肝肾功能的影响[J].河北医药,2016,38(9):1327-1329
[12]郭彦利,邱颖,陈满秋.急性呼吸窘迫综合征的生物标志物研究进展[J].中华急诊医学杂志,2016,25(4):542-545
[13]薛继萍,吴见孚,邵素凤.乌司他丁对全身炎症反应综合征患者免疫功能的影响[J].中国血液流变学杂志,2010,20(2):248-291
[14]罗帮镇,谢南姿,刘阳,等.乌司他丁注射液对急性肺损伤循环内皮祖细胞血管生成能力的影响[J].中西医结合心脑血管病杂志,2016,14(6):594-596
[15]徐敏,乔鲁军.不同剂量乌司他丁对严重脓毒症患者降钙素原、白介素-10及28d死亡率的影响[J].中国老年学杂志,2015,35(24):7166-7168
[16]张朝贵,张春林,曹良海.乌司他丁联合大剂量氨溴索对急性呼吸窘迫综合征患者细胞因子的影响[J].实用临床医药杂志,2015,19(19):9-12
[2]颜洪顺,王志峰.乌司他丁联合东莨菪碱治疗急性呼吸窘迫综合征疗效观察[J].现代中西医结合杂志,2016,25(11):1220-1240
[3]陈蝶,彭再梅.急性呼吸窘迫综合征生物标志物与生物治疗研究[J].中华急诊医学杂志,2016,25(3):264-267
[4]周娜,李来传,史有奎,等.血必净联合乌司他丁静脉注射对ARDS患者支气管肺泡灌洗液中相关细胞因子的影响[J].山东医药,2015,55(45):71-72
[5] Ranieri VM,Rubenfeld GD,Thompson BT,et al. Acute respiratory distress syndrome:the Berlin Definition[J].JAMA,2012,307(23):2526-2533
[6]李亚华,陈刚.甲强龙、低分子肝素对肺脂肪栓塞致急性呼吸窘迫综合征的防治作用的研究[J].中华急诊医学杂志,2016,25(3):310-313
[7]陈晖,王丹,李亚明,等.急性呼吸窘迫综合征患者白介素6及白介素8水平变化研究[J].中国全科医学,2016,19(5):538-541
[8]田昭涛,冯慧远,李慧丽,等.乌司他丁对术后炎症反应和血液高凝状态的影响机制研究[J].中华医院感染学杂志,2014,24(4):853-856
[9]郝建文.急诊呼吸机治疗急性呼吸窘迫综合征86例疗效观察[J].中国基层医药,2013,20(8):1207-1208
[10]刘军.正确理解危重病免疫与炎症的关系[J].中华医学杂志,2017,97(7):483-486
[11]吴永强,赵景成,杨坤,等.无创呼吸机联合乌司他丁对急性呼吸衰竭综合征患者免疫及肝肾功能的影响[J].河北医药,2016,38(9):1327-1329
[12]郭彦利,邱颖,陈满秋.急性呼吸窘迫综合征的生物标志物研究进展[J].中华急诊医学杂志,2016,25(4):542-545
[13]薛继萍,吴见孚,邵素凤.乌司他丁对全身炎症反应综合征患者免疫功能的影响[J].中国血液流变学杂志,2010,20(2):248-291
[14]罗帮镇,谢南姿,刘阳,等.乌司他丁注射液对急性肺损伤循环内皮祖细胞血管生成能力的影响[J].中西医结合心脑血管病杂志,2016,14(6):594-596
[15]徐敏,乔鲁军.不同剂量乌司他丁对严重脓毒症患者降钙素原、白介素-10及28d死亡率的影响[J].中国老年学杂志,2015,35(24):7166-7168
[16]张朝贵,张春林,曹良海.乌司他丁联合大剂量氨溴索对急性呼吸窘迫综合征患者细胞因子的影响[J].实用临床医药杂志,2015,19(19):9-12