目的探讨大剂量乌司他丁联合肺保护性通气对危重疾病合并急性肺损伤/急性呼吸窘迫综合征患者呼吸功能的影响。方法采用回顾性方法,分析安徽医科大学第二附属医院重症医学科(ICU)危重疾病合并急性肺损伤/急性呼吸窘迫综合征患者资料,根据是否使用大剂量乌司他丁联合保护性通气治疗,分为治疗组和对照组;记录患者治疗过程中的肺毛细血管通透指数(pulmonary vascular permeability index,PVPI)、血管外肺水指数(extravascular lung water index,EVLWI)、氧合指数、患者全身炎症反应持续天数、ICU入住天数及APACHEⅡ评分等指标。采用SPSS 19.0软件进行统计分析。结果共纳入患者24例,治疗组13例,对照组11例。治疗72小时后,治疗组患者肺毛细血管通透指数(P=0.016)、血管外肺水指数(P=0.045)、全身炎症反应持续时间(P=0.002)、ICU停留时间(P=0.024)以及APACHEⅡ(P=0.002)均较对照组明显降低,而氧合指数较对照组显著升高(P=0.004)。结论大剂量乌司他丁联合保护性通气治疗能降低危重患者全身炎症反应,显著改善危重疾病患者合并急性肺损伤/急性呼吸窘迫综合征患者肺毛细血管通透性,减少毛细血管渗漏,减少血管外肺水,从而改善患者肺氧合情况,降低患者ICU入住时间,改善患者的预后。 Objective To investigate the effects of high-dose ulinastatin combined with lung-protective ventilation on respiratory function in critically ill patients with acute lung injury / acute respiratory distress syndrome. Methods A retrospective analysis was conducted to analyze the data of critically ill patients with acute lung injury / acute respiratory distress syndrome in the Second Affiliated Hospital of Anhui Medical University. According to the use of high-dose ulinastatin combined with protective ventilation, The patients were divided into treatment group and control group. The pulmonary vascular permeability index (PVPI), extravascular lung water index (EVLWI), oxygenation index, systemic inflammation Duration of response, ICU stay days and APACHE II score and other indicators. Using SPSS 19.0 software for statistical analysis. Results A total of 24 patients were included in the treatment group, 13 cases in the control group and 11 cases in the control group. After 72 hours of treatment, pulmonary capillary permeability index (P = 0.016), extra-pulmonary lung water index (P = 0.045), systemic inflammatory response duration (P = 0.002), ICU stay time (P = 0.024) (P = 0.002) were significantly lower than the control group, while the oxygenation index was significantly higher than the control group (P = 0.004). Conclusion High-dose ulinastatin combined with protective ventilation can reduce systemic inflammatory response in critically ill patients and significantly improve pulmonary capillary permeability in critically ill patients with acute lung injury / acute respiratory distress syndrome, reduce capillary leakage and decrease Extravascular lung water, thereby improving patient oxygenation, reducing ICU admission time, improve patient prognosis.