摘要
目的探讨低分子肝素钠持续气道内给药联合静脉滴注乌司他丁治疗吸入性损伤的效果。方法选择2017年1月至2019年12月黑龙江省医院烧伤科收治的24例大面积烧伤合并吸入性损伤致急性肺损伤的患者,回顾性分析其病例资料。按随机数字表法将患者分为治疗组和对照组,每组12例。对照组给予常规治疗,包括补液抗休克、创面处理、营养支持、抗感染和气道管理等综合治疗。治疗组在对照组治疗的基础上,给予低分子肝素钠溶液持续气道内滴入(100 AxaIU/kg,1次/d)联合静脉滴注乌司他丁(10万U/次,3次/d)治疗2周。治疗前、治疗2周后,采用急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分评估2组患者总体病情;采用放射免疫分析法定量测定2组患者血浆肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)水平;对患者血气指标(氧分压、二氧化碳分压、血液pH值及氧合指数)进行测定,并观察2组患者治疗2周后的病死率。数据比较采用t检验和χ^2检验。结果治疗前,对照组和治疗组患者APACHEⅡ评分比较差异无统计学意义(P>0.05);治疗2周后,治疗组患者APACHEⅡ评分(12.1±3.3)分,明显低于对照组[(17.3±4.2)分],2组比较差异有统计学意义(t=6.31,P<0.05)。治疗前,对照组和治疗组患者血浆TNF-α和CRP水平比较,差异均无统计学意义(P值均大于0.05);治疗2周后,治疗组患者血浆TNF-α和CRP分别为(4.3±0.4)、(10.1±3.7)μg/L,明显低于对照组[(23.1±4.2)、(26.6±4.4)μg/L],2组比较差异均有统计学意义(t=4.32、3.34,P值均小于0.05)。治疗前,对照组和治疗组患者氧分压、二氧化碳分压、血液pH值及氧合指数比较,差异均无统计学意义(P值均大于0.05);治疗2周后,对照组和治疗组患者血液pH值分别为7.43±0.06、7.38±0.23,2组比较差异无统计学意义(t=0.18,P>0.05);治疗组的氧分压和氧合指数分别为(91.4±4.1)mmHg(1 mmHg=0.133 kPa)、351.2±31.5,明显高于对照组[(73.6±3.8)mmHg、286.3±21.1],2组比较差异均有统计学意义(t=3.25、2.56,P值均小于0.05);治疗组患者二氧化碳分压为(35.1±3.9)mmHg,明显低于对照组[(41.8±3.2)mmHg],差异有统计学意义(t=2.13,P<0.05)。治疗2周后,治疗组的病死率为8.33%(1/12),与对照组[25.00%(3/12)]比较明显降低,差异有统计学意义(χ^2=4.26,P<0.05)。结论低分子肝素钠持续气道内给药联合静脉滴注乌司他丁治疗吸入性损伤可明显抑制炎症反应,改善肺功能,降低病死率。
Objective To investigate the effect of continuous airway administration of low molecular weight heparin sodium combined with intravenous infusion of ulinastatin in the treatment of inhalation injury.Methods From January 2017 to December 2019,24 patients with acute lung injury caused by massive burns combined with inhalation injury admitted to the Department of Burns,Heilongjiang Provincial Hospital were selected and their medical records were retrospectively analyzed.The patients were divided into treatment group and control group according to the random number table method,with 12 cases in each group.The control group was given routine treatment,including comprehensive treatments such as fluid replacement,anti-shock,wound management,nutritional support,anti-infection,and airway management.On the basis of treatment in the control group,the treatment group was given continual airway administration of low molecular weight heparin sodium solution(100 AxaIU/kg,1 time/d)combined with intravenous infusion of ulinastatin(100,000 U/time,3 times/d)treatment for 2 weeks.Before treatment and after 2 weeks of treatment,acute physiology and chronic health evaluation(APACHE)Ⅱscore was used to evaluate the overall condition of the two groups of patients;the plasma levels of tumor necrosis factor-α(TNF-α)and C-reactive protein(CRP)were detected by radio immunoassay;the blood gas indexes(oxygen partial pressure,carbon dioxide partial pressure,blood pH value and oxygenation index)of the patients were detected,and the mortality of the two groups of patients after 2 weeks of treatment was observed.Data were compared by t test andχ^2 test.Results Before treatment,there was no significant difference in APACHEⅡscore between the control group and the treatment group(P>0.05);after 2 weeks of treatment,the APACHEⅡscore(12.1±3.3)points of the treatment group was significantly lower than that of the control group[(17.3±4.2)points],the difference between the two groups was statistically significant(t=6.31,P<0.05).Before treatment,there were no statistically significant differences in plasma TNF-αand CRP levels between the control group and the treatment group(with P values above 0.05);after 2 weeks of treatment,the plasma TNF-αand CRP levels of the treatment group were(4.3±0.4),(10.1±3.7)μg/L,significantly lower than those of the control group[(23.1±4.2),(26.6±4.4)μg/L],the differences between the two groups were statistically significant(t=4.32,3.34;with P values below 0.05).Before treatment,there were no statistically significant differences in oxygen partial pressure,carbon dioxide partial pressure,blood pH value and oxygenation index between the control group and the treatment group(with P values above 0.05);after 2 weeks of treatment,the blood pH value of the patients in the control group and the treatment group were 7.43±0.06 and 7.38±0.23,respectively,there was no statistically significant difference between the two groups(t=0.18,P>0.05);the oxygen partial pressure and oxygenation index of the treatment group were(91.4±4.1)mmHg,351.2±31.5,which were significantly higher than those of the control group[(73.6±3.8)mmHg,286.3±21.1],the differences were statistically significant(t=3.25,2.56;with P values below 0.05);the carbon dioxide partial pressure in the treatment group was(35.1±3.9)mmHg,which was significantly lower than that in the control group[(41.8±3.2)mmHg],the difference was statistically significant(t=2.13,P<0.05).After 2 weeks of treatment,the mortality rate of the treatment group was 8.33%(1/12),which was significantly lower than that of the control group[25.00%(3/12)],the difference was statistically significant(χ^2=4.26,P<0.05).Conclusion Continual airway administration of low molecular weight heparin sodium combined with intravenous infusion of ulinastatin can significantly inhibit inflammation,improve lung function,and reduce the mortality rate.
作者
王树明
刘锐
刘振宝
田枫
井维斌
Wang Shuming;Liu Rui;Liu Zhenbao;Tian Feng;Jing Weibin(Department of Emergency, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin 150040, China;Department of Burns, Heilongjiang Provincial Hospital, Harbin 150036, China)
出处
《中华损伤与修复杂志（电子版）》
CAS
2020年第4期303-307,共5页
Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金
黑龙江省卫生计生委科研课题(2018-082)
黑龙江省青年科学基金(QC2016101)
哈尔滨市科技创新人才研究专项基金(2016RAXYJ069)。
关键词
肝素
低分子量
烧伤
吸入性
输注
静脉内
乌司他丁
Heparin,low-molecular-weight
Burns,inhalation
Infusions,intravenous
Ulinastatin
