摘要
目的探讨乌司他丁(UTI)对重型创伤性脑损伤患者颈内静脉血乳酸及脑氧代谢的影响及其临床意义。方法将医院2011年6月至2014年6月收治的90例患者按随机数字表法分为对照组和观察组,各45例。对照组患者根据病情给予止血、脱水降颅压、抗感染、激素等常规治疗,观察组患者在对照组基础上加用乌司他丁,每次15万U,每日2次,连续治疗5 d。所有患者在受伤后第1,3,5天取颈内静脉血和桡动脉血作乳酸检测和血气分析,观察两组患者颈内静脉血乳酸(JVL)、颈静脉血氧饱和度(Sjv O2)、动脉颈静脉血氧含量差(A-v DO2)、脑氧摄取率(CERO2)及炎性因子[肿瘤坏死因子-α(TNF-α)、白细胞介素(IL)-6,IL-8,IL-10]水平等变化,并评价两组患者治疗28 d后的病死率和病残率。结果两组患者伤后第1天JVL及脑氧代谢指标均高于正常值,但差异无统计学意义(P>0.05)。与伤后第1天比较,伤后第3天及第5天两组患者JVL水平及脑氧代谢指标均明显改善(P<0.05),且观察组改善幅度更明显(P<0.05)。两组患者伤后第1天炎性因子水平比较,差异无统计学意义(P>0.05)。与伤后第1天比较,伤后第3天及第5天两组患者的TNF-α,IL-6,IL-8水平均明显下降,而IL-10水平明显升高(P<0.05),且观察组改善幅度更明显(P<0.05)。观察组患者治疗28 d后的病死率和病残率分别为15.56%和37.78%,明显小于对照组的35.56%和73.33%(P<0.05)。结论乌司他丁能明显降低重型创伤性脑损伤患者颈内静脉血乳酸水平,改善脑氧代谢状况,改善炎性因子水平,从而降低患者的病死率和病残率,值得临床推广。
Objective To investigate the influence of ulinastatin（UTI） on jugular venous blood lactate and brain oxygen metabolism in the patients with severe traumatic brain injury and its clinical significance. Methods Totally 90 patients with severe traumatic brain in-jury admitted to the hospital from June 2011 to June 2014 were divided into the observation group and the control group according to the random number table,45 cases in each group. The patients of the control group were treated with the routine therapy of hemostasis, dehydration reducing intracranial pressure,anti-infection and hormones according to the disease condition,while on this basis the pa-tients of the observation group were given ulinastatin 150 000 U,twice daily,for continuous 5 d. All patients were taken internal jugular vein and radial arterial blood samples on 1,3,5 d after injury for detecting the lactate levels and conducting the blood gas analy-sis. The changes of jugular venous lactate（JVL）,jugular venous oxygen saturation（SjvO2）,arterial jugular venous oxygen content difference （A-vDO2）,cerebral oxygen uptake rate（CERO2）and inflammatory cytokines such as TNF-α,IL-6,IL-8 and IL-10 were observed in the two groups. The disability rate and mortality rate after treatment were evaluated in the two groups. Results JVL and cerebral oxygen metabolism indexes on posttraumatic 1 d in the two groups were higher than the normal values,but the differences were not statistically significant（ P ﹥ 0. 05）;JVL and cerebral oxygen metabolism indexes on posttraumatic 3,5 d in the two groups were significant-ly improved compared with those on posttraumatic 1 d,and the observation group improved more significantly（ P ﹤ 0. 05）;the inflammatory cytokines levels on posttraumatic 1 d in two groups had no statistical significance（ P ﹥ 0. 05）,on posttraumatic 3,5 d the TNF-α,IL-6, IL-8 levels were significantly decreased（ P ﹤ 0. 05）,the levels of IL-10 were significatly increased,and the observation group improved more sig
出处
《中国药业》
CAS
2015年第10期53-55,共3页
China Pharmaceuticals
关键词
乌司他丁
脑损伤
乳酸
脑氧代谢
临床意义
ulinastatin
brain injury
lactate
cerebral oxygen metabolism
clinical significance
