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目的评价蛋白酶抑制剂乌司他丁(UTI)对外科高危病人的疗效,通过观察细胞因子的变化和临床转归的影响来探讨其作用机制。方法选择符合入选标准共58例,随机分为乌司他丁治疗组(U组,n=30)和对照组(C组,n=28)。U组病人在接受标准常规治疗的同时接受蛋白酶抑制剂(UTI)治疗,术后12h内开始静脉注射UTI,每次20万单位,每天两次,连续5d。C组病人接受常规治疗+安慰剂(生理盐水)。在治疗前后24、48、72h测定TNF-α、IL-6、IL-8,一氧化氮(NO)、血乳酸、肌酐(Cr),并进行治疗前、后APACHEII评分,观察住院时间和病死率。结果U组病人IL-6、IL-8、TNF-α、APACHEⅡ评分的平均值较C组显著降低。Cr、NO、血乳酸的浓度在治疗后两组间差异无显著性意义。两组住院时间和病死率差异无显著性意义。结论UTI可抑制外科高危病人促炎因子IL-6、IL-8、TNF-α,降低病人APACHEⅡ评分,但对临床转归有无影响,有待于进一步观察研究。
Objective To evaluate the efficacy of protease inhibitor ulinastatin (UTI) in surgical high-risk patients and to explore its mechanism by observing the changes of cytokines and the clinical outcome. Methods A total of 58 patients were enrolled in the study. They were randomly divided into ulinastatin group (n = 30) and control group (n = 28). Patients in group U were treated with protease inhibitor (UTI) while receiving standard conventional therapy. Intravenous injection of UTI was started within 12 hours after operation. Each time, 200,000 units were administered twice daily for 5 days. Patients in group C received routine therapy plus placebo (saline). The levels of TNF-α, IL-6, IL-8, nitric oxide (NO), blood lactate and creatinine were measured at 24, 48 and 72 h before and after treatment. APACHEII scores were measured before and after treatment. rate. Results The average values of IL-6, IL-8, TNF-α and APACHEⅡ in group U were significantly lower than those in group C Cr, NO, blood lactic acid concentrations after treatment no significant difference between the two groups. There was no significant difference between the two groups in hospitalization time and case fatality rate. Conclusion UTI can inhibit the high-risk surgical patients with proinflammatory cytokines IL-6, IL-8, TNF-α, reduce APACHE Ⅱ score, but it has no effect on the clinical outcome, to be further observed and studied.