Ji Mingxia, Chen Tiejiang, Wang Baiming, Chen Mengyan, Ding Qianqian, Chen Lingchao, Fang Yuejuan, Yu Xiaofang, Chen Yanzhen, Wang Xiaohua, He Yiyue, Jiang Yong
Department of Emergency, Yiwu Central Hospital, Yiwu, Zhejiang 322000, P.R. China.
Exp Ther Med. 2018 Jun;15(6):4665-4670. doi: 10.3892/etm.2018.6012. Epub 2018 Mar 30.
Acute respiratory distress syndrome (ARDS) is a disease that seriously threatens human life and health. The aim of the study was to investigate the effects of ulinastatin combined with mechanical ventilation on oxygen metabolism, inflammation and stress response, as well as the antioxidant capacity of ARDS. Eighty patients with ARDS treated in Yiwu Central Hospital from January, 2015 to December, 2016 were enrolled in the present study and divided into the observation (n=40) and control (n=40) groups, using a random number table. The control group was treated with mechanical ventilation, while the observation group, based on treatment of the control group, was treated with ulinastatin for 14 consecutive days as one course of treatment. The changes in the relevant indexes of oxygen metabolism, lung function, time of ventilator treatment, total hospital stay, and St. George's Respiratory Questionnaire (SGRQ) score of the two groups after intervention were compared, and the changes in inflammatory cytokine levels, dopamine receptor-related hormone levels, superoxide dismutase (SOD), malondialdehyde (MDA) and total antioxidant capacity of the two groups before intervention and at 1 and 4 weeks after intervention were compared. After intervention, the arterial blood lactate in the observation group was significantly lower than that in the control group (P<0.05), the oxygen uptake rate was significantly higher than that in the control group (P<0.05) and the arterial oxygen content was significantly higher than that in the control group (P<0.05). In the lung function indexes, the FEV and FEV/FVC levels in the observation group were smaller than those in the control group (P<0.05), the duration of ventilator treatment was significantly shorter than that in the control group (P<0.05), and the hospital stay was significantly less than that in the control group (P<0.05). Prior to intervention, SGRQ scores in the two groups were not statistically significant (P>0.05). At 1 and 4 weeks after intervention, the SGRQ scores of the observation group were significantly increased to those of the control group (P<0.05). The tumor levels of necrosis factor-α (TNF-α), interleukin-6 (IL-6) and CRP were significantly lower than those of the control group (P<0.05). The levels of adrenaline and norepinephrine were significantly lower than those of the control group (P<0.05). The levels of MDA, SOD and the total antioxidant capacity were significantly increased to those of control group (P<0.05). The application of ulinastatin combined with mechanical ventilation in ARDS patients is of great significance in improving the oxygen delivery-consumption balance of body, increasing the lung function, reducing the inflammatory and stress response, and improving the antioxidant capacity.
急性呼吸窘迫综合征(ARDS)是一种严重威胁人类生命健康的疾病。本研究旨在探讨乌司他丁联合机械通气对ARDS患者氧代谢、炎症及应激反应以及抗氧化能力的影响。选取2015年1月至2016年12月在义乌市中心医院治疗的80例ARDS患者纳入本研究,采用随机数字表法分为观察组(n = 40)和对照组(n = 40)。对照组采用机械通气治疗,观察组在对照组治疗基础上,加用乌司他丁连续治疗14天为1个疗程。比较两组干预后氧代谢、肺功能相关指标、机械通气时间、总住院时间及圣乔治呼吸问卷(SGRQ)评分的变化,以及两组干预前、干预后1周和干预后4周炎症细胞因子水平、多巴胺受体相关激素水平、超氧化物歧化酶(SOD)、丙二醛(MDA)及总抗氧化能力的变化。干预后,观察组动脉血乳酸水平显著低于对照组(P < 0.05),氧摄取率显著高于对照组(P < 0.05),动脉血氧含量显著高于对照组(P < 0.05)。在肺功能指标方面,观察组FEV及FEV/FVC水平低于对照组(P < 0.05),机械通气时间显著短于对照组(P < 0.05),住院时间显著少于对照组(P < 0.05)。干预前,两组SGRQ评分差异无统计学意义(P > 0.05)。干预后1周和干预后4周,观察组SGRQ评分显著低于对照组(P < 0.05)。肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)及CRP水平显著低于对照组(P < 0.05)。肾上腺素和去甲肾上腺素水平显著低于对照组(P < 0.05)。MDA、SOD水平及总抗氧化能力显著高于对照组(P < 0.05)。乌司他丁联合机械通气应用于ARDS患者,对改善机体氧输送-消耗平衡、提高肺功能、减轻炎症及应激反应、提高抗氧化能力具有重要意义。