摘要
目的探讨乌司他丁对急性心肌梗死患者心肺复苏术(CPR)后多脏器功能的保护作用。方法对ICU急性心肌梗死CPR后的50例危重患者,随机分为乌司他丁干预组(25例)和综合治疗对照组(25例),对两组的临床和实验室指标进行观察比较。结果两组患者的年龄和CPR后的APACHE-Ⅱ评分比较,差异无统计学意义(P>0.05),有可比性。干预组机械通气时间为(257.81±97.65)h,显著短于对照组[(425.33±81.57)h,P=0.000];因发生多器官功能衰竭而死亡患者干预组6/25(24%)例,对照组15/25(60%)例,两组间比较差异均有统计学意义(P<0.05);干预组治疗第1天的肌酸激酶同工酶值为(185.13±13.36)U/L,与对照组(183.12±12.57)U/L比较,差异无统计学意义(P=0.5863);干预组治疗第3和第5天的肌酸激酶同工酶值为(110.56±12.14)U/L和(39.73±10.37)U/L,均显著低于对照组(167.35±11.49)U/L和(73.52±10.18)U/L,P<0.05);治疗前后MODS评分结果显示对照组无明显改善,干预组明显降低,治疗第5天干预组MODS评分为(1.59±1.36),明显低于对照组(2.96±0.23,P<0.05)。结论乌司他丁对急性心肌梗死患者能改善其心肌酶学和降低心律失常的发生率,乌司他丁对急性心肌梗死CPR后多脏器功能有保护作用。
Objective To investigate the protective effects of ulinastatin on multiple organs in the patients with myocardial infarction （MI） after cardiopulmonary resuscitation （CPR）. Methods Fifty patients with MI after CPR,29 males and 21 females, aged （58.02±15.25） （39-78）, were randomly divided into 2 equal sex, age, and APACHE-Ⅱ score-matched groups： intervention group treated with ulinastatin and control group receiving routine management. Then compare the relative clinical and laboratory components between the two groups. Resu Its The rate of discharge or transfer from ICU of the intervention group was 76%, significantly higher than that of the control group （40%, P 〈0.05）. The total mortality was 42%, and the patients who died all had the APACHE-Ⅱ scores 〉25. No ventilar induced lung injury occurred in the 2 groups. The ventilar-associated pneumonia rate, severe arrhythmia rate, mortality due to MODS of the intervention group were 12%, 16%, and 24% respectively, all significantly lower than those of the control group （36%, 44%, and 60% respectively, all P 〈0.05）. The level of creatine kinase isoenzyme at the first day of the control group was （183.12±12.57） U/L, not significantly different from that of the intervention group [（185.13±13.36）U/L, P =0.5863] ; andthe levels of creatine kinase isoenzyme at the third and fifth days of the intervention group were （110.56±12.14）and （39.73±10.37）U/L respectively, both significantly lower than those of the control group were [（167.35±11.49） and （73.52±10.18）U/L respectively, both P =0.0000]. The mean blood pressure and heart rate 5 days after treatment of the intervention group was （99.59±13.75） mmHg, significantly higher than that of the control group [（57.24± 11.13）mmHg ,P =0.0000], and the heart rate of the intervention group 5 days after treatment was （107.39 ±12.03）bpm, significantly lower than that of the control group [（118.59 ±21.85）bpm, P 〈0.05]. The MODS score 5 days after mechanical ventilation of the intervention group was （1.59±1.36）, significantly lower than that of the control group （2.96±0.23, P 〈0.05）. Conclusion Decreasing the CK-MB level and incidence of arrhythmia, ulinastatin has protective effects in MI patients after CPR.
出处
《中国急救复苏与灾害医学杂志》
2008年第3期134-137,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
乌司他丁
急性心肌梗死
心脏骤停
CPR
MODS
临床研究
Ulinastatin
Myocardial infarction
Cardiac arrest
Cardiopulmonary resuscitation （CPR）
Multiple orgen dysfunction syndrome （MODS）
