| 张润娟,向永红,张钦哲,等.痰热清联合乌司他丁对脓毒症急性肺损伤病人呼吸功能及氧化应激指标的影响[J].安徽医药,2024,28(11):2291-2296. |
| 痰热清联合乌司他丁对脓毒症急性肺损伤病人呼吸功能及氧化应激指标的影响 |
| Effects of Tanreqing combined with ulinastatin on respiratory function and oxidative stress indexes in patients with sepsis-induced acute lung injury |
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| DOI：10.3969/j.issn.1009-6469.2024.11.039 |
| 中文关键词: 脓毒症 急性肺损伤 痰热清 乌司他丁 呼吸功能 氧化应激反应 |
| 英文关键词: Sepsis Acute lung injury Tanreqing Ulinastatin Respiratory function Oxidative stress response |
| 基金项目: |
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| 中文摘要: |
| 目的探讨痰热清联合乌司他丁对脓毒症急性肺损伤( ALI)病人呼吸功能及氧化应激指标的影响。方法选取广西壮族自治区民族医院 2020年 12月至 2023年 11月 86例脓毒症 ALI病人，按随机数字表法分为观察组 43例及对照组 43例。两组均予以常规治疗，对照组予以乌司他丁，观察组予以痰热清联合乌司他丁。比较两组疗效、症状及病情变化［急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ)评分、 Murray肺损伤评分( MLIS)］、治疗前后呼吸功能［血管外肺水指数( EVLWL)、肺血管通透指数(PVPI)氧合指数(PaO2/FiO2)］、氧化应激指标［过氧化脂( LPO)过氧化氢酶( CAT)、超氧化物歧化酶(SOD)］、核转录因子 -κB(NF-κB)信、号通路表达、预后。结果两组整体疗效比较，差异无统、计学意义( P>0.05)；治疗 7d后，两组中医证候积分、 APACHEⅡ评分、 MLIS均低于治疗前，但两组间比较，差异无统计学意义( P>0.05)；治疗 7d后，两组 EVLWL、PVPI较治疗前明显降低( P<0.05)，且观察组 EVLWL、PVPI分别为( 8.02±1.05)mL/kg、(1.91±0.36)%，均低于对照组( 11.34±1.62)mL/kg、(2.67±0.43)%(P<0.05)；治疗 7d后，两组 PaO2/FiO2较治疗前明显升高( P<0.05)且观察组 PaO2/FiO2为( 407.26±33.9)mmHg，于对照组( 326.84±28.65)mmHg(P<0.05)；治疗 7d后，两组 LPO较治疗前明显降低(，P<0.05)，且观察组 LPO为( 3.45±0.82)nmol/高L，低于对照组(5.06±1.04)nmol/L(P<0.05)；治疗 7d后，两组 CAT、SOD较治疗前明显升高(P<0.05)，且观察组 CAT、SOD分别为(54.04±7.26)U/mL、(106.35±8.87)U/mL，高于对照组( 48.59±6.47)U/mL、(92.41±6.92)U/mL(P<0.05)；治疗 7d后，两组 NF-κB、 IL-6、TNF-α较治疗前明显降低( P<0.05)，且观察组 NF-κB、IL-6、TNF-α分别为( 12.08±3.23)mg/L、(132.06±18.8)ng/L、(170.15±20.29)ng/L，低于对照组( 20.64±4.52)mg/L、(165.75±23.26)ng/L、(202.64±26.32)ng/L(P<0.05)；观察组机械通气时间为( 6.89±1.37)d，短于对照组( 8.56±1.61)d(P<0.05)；两组 ICU入住时间、 28 d生存率、并发症发生率比较，差异无统计学意义( P>0.05)。结论痰热清联合乌司他丁治疗脓毒症治疗 ALI病人能促进呼吸功能恢复，改善氧化应激反应，缩短机械通气时间，其作用机制可能与调节 NF-κB信号通路表达有关。 |
| 英文摘要: |
| Objective To explore the effects of Tanreqing combined with ulinastatin on respiratory function and oxidative stress indexes in patients with sepsis-induced acute lung injury (ALI).Methods A total of 86 patients with sepsis-induced ALI in National Hospital of Guangxi Zhuang Autonomous Region were enrolled between December 2020 and November 2023. According to randomnumber table method, they were divided into observation group (n=43) and control group (n=43). On the basis of routine treatment, control group was treated with ulinastatin, while observation group was treated with Tanreqing + ulinastatin. The curative effect, changes ofsymptoms and disease [scores of APACHE Ⅱ and Murray lung injury scale (MLIS)], respiratory function [extravascular lung water index (EVLWL), pulmonary vascular permeability index (PVPI), oxygenation index (PaO2/FiO2)], oxidative stress indexes [lipid peroxide(LPO), catalase (CAT), superoxide dismutase (SOD)] and expression of nuclear transcription factor-κB (NF-κB) signaling pathway before and after treatment, and prognosis were compared between the two groups.Results There was no significant difference in overall efficacy between the two groups (P>0.05). After 7 d of treatment, scores of TCM syndromes, APACHE Ⅱ and MLIS were decreased inboth groups, but there was no significant difference between the two groups (P>0.05). After 7 d of treatment, EVLWL and PVPI were significantly decreased in both groups (P<0.05), which in observation group were (8.02±1.05)mL/kg and (1.91±0.36)% , lower than those in control group [(11.34±1.62)mL/kg, (2.67±0.43)%, P<0.05]. After 7d of treatment, PaO2/FiO2 was significantly increased in both groups (P<0.05), which was higher in observation group than control group [(407.26±33.9)mmHg vs. (326.84±28.65)mmHg, P<0.05]. After 7d of treatment,LPO was significantly decreased in both groups (P<0.05), which was lower in observation group than control group [(3.45±0.82)nmol/L vs. (5.06±1.04)nmol/L, P<0.05]. After 7d of treatment, CAT and SOD were significantly increased in both groups (P <0.05), which in observation group were (54.04±7.26)U/mL and (106.35±8.87)U/mL, higher than those in control group [(48.59±6.47)U/mL, (92.41±6.92)U/mL, P<0.05]. After 7d of treatment,NF-κB, IL-6 and TNF-α were significantly decreased in both groups (P<0.05),which in observation group were (12.08±3.23)mg/L, (132.06±18.8)ng/L and (170.15±20.29)ng/L, lower than those in control group[(20.64±4.52)mg/L, (165.75±23.26)ng/L, (202.64±26.32)ng/L,P<0.05].The mechanical ventilation time in observation group was shorter than that in control group [(6.89±1.37)d vs. (8.56±1.61)d, P<0.05]. There was no significant difference in stay time in ICU, 28d survival rate or incidence of complications between the two groups (P>0.05).Conclusion Tanreqing combined with ulinastatin can promote the recovery of respiratory function, improve oxidative stress response and shorten mechanical ventilation time in patients withsepsis-induced ALI, and the action mechanism may be related to regulating the expression of NF-κB signaling pathway. |
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