乌司他丁治疗重型颅脑损伤后急性肺损伤的疗效观察

Curative Effect of Ulinastatin in the Treatment of Acute Lung Injury after Severe Traumatic Brain Injury

关键词:  重型颅脑损伤  急性肺损伤  临床疗效观察  机制

Key words:  severe traumatic brain injury  acute lung injury  clinical observation  mechanism

摘要:

目的 观察乌司他丁对重型颅脑损伤后急性肺损伤的治疗效果。方法 100例重型颅脑损伤后急性肺损伤患者随机分为对照组和治疗组，每组50例。对照组常规治疗，治疗组加用乌司他丁治疗。采用ELISA法检测患者治疗前和治疗后10 d血浆白介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、S100B蛋白、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、髓鞘碱性蛋白(MBP)、肺表面活性蛋白D(SP-D)和Clara细胞蛋白浓度，观察治疗后3个月格拉斯哥昏迷(GCS)评分。结果 治疗前对照组和治疗组血浆IL-6、CRP、TNF-α、S100B蛋白、NSE、GFAP、MBP、SP-D和Clara细胞蛋白浓度无显著差异；与治疗前比较，对照组和治疗组上述指标均显著降低，治疗组指标显著低于对照组。治疗后3个月，GCS评分显示，对照组恢复良好5例，中度残疾7例，重度残疾11例，植物生存11例，死亡16例；治疗组恢复良好13例，中度残疾14例，重度残疾6例，植物生存8例，死亡9例，治疗组预后显著优于对照组。结论 乌司他丁对重型颅脑损伤后急性肺损伤具有显著治疗效果，其机制可能与抑制机体炎症反应从而降低脑肺功能损伤有关。

Abstract:

OBJECTIVE To explore the curative effect of ulinastatin on acute lung injury after severe traumatic brain injury. METHODS One hundred patients with acute lung injury after severe traumatic brain injury were randomLy divided into control group and treatment group with fifty patients in each group. Control group obtained common treatment and treatment group obtained common treatment plus ulinastatin. The concentration of plasma interleukin-6(IL-6), C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), S100B protein, neuron specific enolase(NSE), glial fibrillary acidic protein(GFAP), myelin basic protein(MBP), surfactant protein D(SP-D), and Clara cell protein was measured by ELISA before treatment and ten days after treatment. Glasgow outcome scale(GCS) scores were investigated three months after treatment. RESULTS Before treatment, the concentration of plasma IL-6, CRP, TNF-α, NSE, GFAP, MBP, SP-D, S100B protein, and Clara cell protein in control group and treatment group was compared, and there was no significant difference. After treatment, the above concentration was obviously lower than before treatment in both control group and treatment group. After treatment, the concentration of plasma IL-6, CRP, TNF-α, NSE, GFAP, MBP, SP-D, S100B protein, and Clara cell protein in treatment group was significantly lower than in control group. Three months after treatment, GCS scores suggested that 5 patients had good recovery, 7 patients had moderate disability, 11 patients had severe disability, 7 patients kept persistent vegetative state and 16 patients died in the control group. Thirteen patients had good recovery, 14 patients had moderate disability, 6 patients had severe disability, 8 patients kept persistent vegetative state and nigh patients died in the treatment group. The prognosis was obviously better in treatment group than in control group. CONCLUSION Ulinastatin exerts obviously curative effect on acute lung injury after severe traumatic brain injury. Its mechanism may be related to the improvement of brain and pulmonary injury by inhibiting the inflammatory response.