CAJ | 학술논문

目的：研究乌司他丁（ ulinastatin）对吸入性损伤患者早期炎症反应的影响及肺功能保护作用。方法：43例重症烧伤合并吸入性损伤患者，随机分为乌司他丁治疗组（21例）和对照组（22例），两组常规治疗一致，乌司他丁组在此基础上给予1万U/（ kg· d）静脉滴注，连续用药7 d。分别于治疗开始前、治疗后第1天、第4天、第7天检测血气分析指标、C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、白细胞介素-10（IL-10）、过氧化物歧化酶（SOD）含量，并记录第1天、第4天、第7天、第14天患者APACHEⅡ评分及治疗14 d内肺部感染发生情况。结果：与对照组相比，乌司他丁治疗后第4天、第7天，动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）、IL-10、SOD明显升高，TNF-α、IL-6明显下降，差异均有统计学意义（P＜0．05）；治疗后第7天CRP明显下降，差异有统计学意义（P＜0．05）；治疗14 d内各时间点两组患者APACHEⅡ评分差异无统计学意义；乌司他丁治疗组肺部感染发生率较低，发生时间较迟。结论：吸入性损伤早期采用乌司他丁回补策略作为一种有效的辅助治疗方式，可减轻患者的炎症反应，改善呼吸功能，减少肺部感染发生。
목적：연구오사타정（ ulinastatin）대흡입성손상환자조기염증반응적영향급폐공능보호작용。방법：43례중증소상합병흡입성손상환자，수궤분위오사타정치료조（21례）화대조조（22례），량조상규치료일치，오사타정조재차기출상급여1만U/（ kg· d）정맥적주，련속용약7 d。분별우치료개시전、치료후제1천、제4천、제7천검측혈기분석지표、C반응단백（CRP）、종류배사인자-α（TNF-α）、백세포개소-6（IL-6）、백세포개소-10（IL-10）、과양화물기화매（SOD）함량，병기록제1천、제4천、제7천、제14천환자APACHEⅡ평분급치료14 d내폐부감염발생정황。결과：여대조조상비，오사타정치료후제4천、제7천，동맥혈양분압（PaO2）、양합지수（PaO2/FiO2）、IL-10、SOD명현승고，TNF-α、IL-6명현하강，차이균유통계학의의（P＜0．05）；치료후제7천CRP명현하강，차이유통계학의의（P＜0．05）；치료14 d내각시간점량조환자APACHEⅡ평분차이무통계학의의；오사타정치료조폐부감염발생솔교저，발생시간교지。결론：흡입성손상조기채용오사타정회보책략작위일충유효적보조치료방식，가감경환자적염증반응，개선호흡공능，감소폐부감염발생。
Objective:To observe the effects of ulinastatin on inflammatory response and early pulmonary function in the patients with burn and smoke in-halation injury.Methods:Forty-three patients with severe inhalation injury were randomly allocated to the experimental group (n=21) and control group ( n=22 ) .Two groups of patients received conventional therapy of burn injury ,and the experimental group were given additional intravenous drip of ulinas-tatin in dose of 10 000 U/(kg· d) for 7 days.Before treatment and at day 1,4 and 7 after treatment,blood samples were taken from peripheral veins for determination of C-reactive protein (CRP),TNF-α,IL-6,IL-10 and SOD activities.Besides,APACHEⅡ scoring was maintained at day 1,4,7 and 14,re-spectively,for evaluation of the incidence of pulmonary infection in the two groups.Results:By comparison with the control group at day 4 and 7 after treat-ment,significantly elevated PaO2,PaO2/FiO2,IL-10 and SOD,yet markedly reduced TNF-αand IL-6 levels were observed in patients from experimental group,and the CRP level was also significantly lowed,which showed statistical difference(P<0.05).Although the APACHEⅡ scores had no significant difference between two groups, the experimental group had lower incidence rate and delayed occurrence of pneumonia within 14 days of therapy. Conclusion:Complementary therapy with ulinastatin during the early phase may effectively inhibit the inflammatory response ,improve the pulmonary func-tion and reduce the incidence of pneumonia for patients with burn and smoke-induced inhalation injury.