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目的观察乌司他丁对重症肺炎患者血乳酸、中心静脉血氧饱和度(ScvO2)和D-二聚体的影响。方法比较重症肺炎乌司他丁干预组和常规治疗组入院时、治疗后6、24、72、120h动脉血乳酸、ScvO2和D-二聚体水平,以及治疗前、治疗120h后APACHEⅡ评分变化。结果治疗前两组患者血ScvO2均低于理想水平(75%),治疗后两组患者ScvO2水平均较治疗前明显升高(P<0.05)。乌司他丁干预组ScvO2在治疗后6h后达到理想水平,明显早于常规治疗的组(P<0.05),且Sc-vO2维持﹥75%,明显高于常规治疗组(P<0.05)。乌司他丁干预组患者血乳酸水平在治疗6、24、72h和120h后明显低于常规治疗组(P<0.05)。两组患者D-二聚体在治疗前明显升高,乌司他丁干预组D-二聚体在治疗24h开始下降(P<0.01),72h显著下降,120h基本恢复正常,常规治疗组D-二聚体在治疗72h开始下降,至120h仍高于正常。两组患者治疗120h后,A-PACHEⅡ评分均减低,乌司他丁干预组APACHEⅡ评分显著低于常规治疗组(P<0.05)。结论重症肺炎患者早期应用乌司他丁可以明显改善组织缺氧程度,减少微血栓形成,改善组织灌注,有效提高患者预后。
Objective To observe the effects of ulinastatin on blood lactic acid, central venous oxygen saturation (ScvO2) and D-dimer in patients with severe pneumonia. Methods The arterial blood lactic acid, ScvO2 and D-dimer levels at 6, 24, 72 and 120 h after PCI were compared between the intervention group and the conventional treatment group. The changes of APACHE Ⅱ score before and 120 h after the treatment were compared. Results Before treatment, blood ScvO2 in both groups was lower than the ideal level (75%). ScvO2 levels in both groups were significantly higher than those before treatment (P <0.05). The ulinastatin intervention group ScvO2 reached the ideal level 6h after treatment, significantly earlier than the conventional treatment group (P <0.05), and Sc-vO2 maintained> 75%, significantly higher than the conventional treatment group (P <0.05). The levels of serum lactate in the ulinastatin intervention group were significantly lower than those in the conventional treatment group at 6, 24, 72 and 120 hours (P <0.05). D-dimer was significantly increased in both groups before treatment, D-dimer in the ulinastatin intervention group began to decrease at 24 h (P <0.01), decreased significantly at 72 h, and returned to normal at 120 h. In the conventional treatment group D - dimer began to decline in the treatment of 72h, 120h still higher than normal. A-PACHEⅡscore decreased after 120h treatment in both groups, APACHEⅡscore in ulinastatin intervention group was significantly lower than that of routine treatment group (P <0.05). Conclusion The application of ulinastatin in patients with severe pneumonia can significantly improve the degree of hypoxia, reduce the formation of microthrombus, improve tissue perfusion, and effectively improve the prognosis of patients.