2021 年第 3 期 第 16 卷

乌司他丁联合同步间歇指令通气及呼气末正压机械通气对急性呼吸窘迫综合征患者炎症因子水平及肺功能的影响

Effect of ulinastatin combined with synchronized intermittent mandatory ventilation and positive end expiratory pressure mechanical ventilation on inflammatory factors levels and lung function in patients with acute respiratory distress syndrome

作者：邓文君李燕陈翔宇谢彬

英文作者：Deng Wenjun Li Yan Chen Xiangyu Xie Bin

单位：陆军军医大学第一附属医院急救部,重庆400038

英文单位：Department of Emergency the First Affiliated Hospital of Army Medical University Chongqing 400038 China

关键词：急性呼吸窘迫综合征；机械通气；乌司他丁；肺顺应性

英文关键词：Acuterespiratorydistresssyndrome;Mechanicalventilation;Ulinastatin;Lungcompliance

• 摘要：

• 目的 探究乌司他丁联合同步间歇指令通气(SIMV)及呼气末正压(PEEP)机械通气对急性呼吸窘迫综合征(ARDS)患者炎症因子水平及肺功能的影响。方法 选取2019年2月至2020年3月于陆军军医大学第一附属医院接受治疗的ARDS患者104例，根据随机数字表法分为对照组与观察组，各52例。对照组患者在常规治疗基础上予SIMV治疗，观察组在常规治疗基础上予乌司他丁静脉滴注联合SIMV+PEEP机械通气治疗，2组均连续治疗7 d。比较2组治疗前后炎症因子、肺静态顺应性（Cst）、动脉血气分析及肺功能指标水平。记录治疗期间并发症发生情况。结果 治疗后，观察组白细胞介素6、肿瘤坏死因子α、S100钙结合蛋白A12及克拉拉细胞蛋白16水平均低于对照组［（21.8±0.8）ng/L比（37.9±1.9）ng/L、（39.9±1.7）ng/L比（44.2±2.8）ng/L、（101±11）μg/L比（133±13）μg/L、（0.16±0.02）ng/L比（0.39±0.03）ng/L］，Cst水平高于对照组［（237±19）ml/cmH2O比（201±19）ml/cmH2O］（1 cmH2O=0.098 kPa），差异均有统计学意义（均P<0.05）。治疗后，观察组动脉血氧分压（PaO2）、PaO2/吸入氧浓度比值均高于对照组，动脉血二氧化碳分压低于对照组；观察组用力肺活量（FVC）、第1秒用力呼气容积（FEV1）、FEV1/FVC比值均高于对照组［（1.96±0.21）L比（1.51±0.14）L、（2.35±0.22）L比（1.75±0.19）L、（68±7）%比（50±5）%］；差异均有统计学意义（均P＜0.05）。治疗期间观察组并发症发生率低于对照组［5.8%（3/52）比21.2%（11/52）］（χ2=5.283，P=0.020）。结论 乌司他丁联合SIMV＋PEEP机械通气能够降低ARDS患者炎症反应程度、提高肺静态顺应性、改善肺功能，临床效果明显。

• Objective To explore the effect of ulinastatin combined with synchronized intermittent mandatory ventilation（SIMV）and positive end expiratory pressure（PEEP） mechanical ventilation on inflammatory factors levels and lung function in patients with acute respiratory distress syndrome（ARDS）. Methods Totally 104 patients with ARDS treated in the First Affiliated Hospital of Army Medical University from February 2019 to March 2020 were selected and randomly divided into control group and observation group, with 52 cases in each group. The control group was treated with SIMV and the observation group was treated with ulinastatin intravenous drip combined with SIMV+PEEP mechanical ventilation. Both groups were treated for 7 d. The levels of inflammatory factors, compliance of static lung（Cst）, arterial blood gas analysis and lung function indexes were compared between the two groups. The incidence of complications during the treatment was recorded. Results After treatment, the levels of interleukin-6, tumor necrosis factor-α, S100 calcium binding protein A12 and Clara cell protein 16 of the observation group were lower than those of the control group［（21.8±0.8）ng/L vs （37.9±1.9）ng/L,（39.9±1.7）ng/L vs （44.2±2.8）ng/L,（101±11）μg/L vs （133±13）μg/L,（0.16±0.02）ng/L vs （0.39±0.03）ng/L］, and Cst level of observation group was higher than that of control group［（237±19）ml/cmH2O vs （201±19）ml/cmH2O］（all P<0.05）. After treatment, Arterial oxygen partial pressure（PaO2）, value of PaO2/inhaled oxygen concentration of the observation group were higher than those of the control group, and arterial carbon dioxide partial pressure of the observation group was lower than that of the control group; forced vital capacity(FVC), forced expiratory volume in first second(FEV1) and value of FEV1/FVC of the observation group were higher than those of the control group［（1.96±0.21）L vs （1.51±0.14）L,（2.35±0.22）L vs （1.75±0.19）L,（68±7）% vs （50±5）%］（all P<0.05）. Complication rate in observation group was lower than that in control group during treatment［5.8%（3/52）vs 21.2%（11/52）］（χ2=5.283，P=0.020）. Conclusion Ulinastatin combined with SIMV+PEEP mechanical ventilation can reduce the degree of inflammatory reaction, improve the compliance of lung static and lung function, and the clinical effect is obvious.