大面積燒傷患者圍手術(shù)期使用烏司他丁對(duì)心肌的保護(hù)作用

楊恒連+肖虎

【摘要】 目的 探討大面積燒傷患者圍手術(shù)期使用烏司他丁對(duì)心肌的保護(hù)作用。方法 66例進(jìn)行手術(shù)治療的大面積燒傷患者作為研究對(duì)象， 隨機(jī)分為觀察組與對(duì)照組， 每組33例。兩組患者入院后均給予常規(guī)方法進(jìn)行治療， 觀察組在以上治療的基礎(chǔ)上加用烏司他丁注射液治療。治療前及治療4、7 d時(shí)測(cè)定兩組氨基末端腦鈉肽前體（NT-proBNP）和心型脂肪酸結(jié)合蛋白（h-FABP）水平， 并進(jìn)行組間比較。結(jié)果 兩組治療前血漿NT-proBNP比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；治療4 d時(shí)兩組血漿NT-proBNP達(dá)到峰值， 且觀察組血漿NT-proBNP（421.4±38.4）ng/ml明顯低于對(duì)照組（592.5±36.1）ng/ml，

差異具有統(tǒng)計(jì)學(xué)意義（P<0.01）；治療7 d時(shí)兩組血漿NT-proBNP均有降低， 且觀察組血漿NT-proBNP

（136.2±28.1）ng/ml明顯低于對(duì)照組（301.1±29.5）ng/ml， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.01）。兩組治療前血漿h-FABP比較差異無統(tǒng)計(jì)學(xué)意義（P>0.05）；治療4 d時(shí)兩組血漿h-FABP達(dá)到峰值， 且觀察組血漿h-FABP（19.15±3.37）ng/ml明顯低于對(duì)照組（23.83±3.01）ng/ml， 差異具有統(tǒng)計(jì)學(xué)意義（P<0.01）；治療7 d時(shí)兩組血漿h-FABP均有降低， 且觀察組血漿h-FABP（2.09±0.41）ng/ml明顯低于對(duì)照組（5.91±0.37）ng/ml，

差異具有統(tǒng)計(jì)學(xué)意義（P<0.01）。結(jié)論 大面積燒傷患者圍手術(shù)期使用烏司他丁可以減輕心肌損傷， 有利于患者恢復(fù)。

【關(guān)鍵詞】 大面積燒傷；烏司他丁；心肌

DOI：10.14163/j.cnki.11-5547/r.2018.01.045

【Abstract】 Objective To discuss the protective effect of ulinastatin on the myocardium in patients with large area burns during the perioperative period. Methods A total of 66 patients with large area burns undergoing surgical treatment as study subjects were randomly divided into observation group and control group， with 33 cases in each group. Both groups was treated with conventional therapy， and the observation group was also treated with ulinastatin injection. The levels of N-terminal pro brain natriuretic peptide （NT-proBNP） and heart type fatty acid binding protein （h-FABP） before and after treatment for 4 and 7 d in two groups were measured and compared. Results Both groups had no statistically significant difference in plasma NT-proBNP before treatment （P>0.05）. After 4 d of treatment， the plasma NT-proBNP reached its peak value in the two groups， and the observation group had obviously lower plasma NT-proBNP as （421.4±38.4） ng/ml than （592.5±36.1） ng/ml in the control group. Their difference was statistically significant （P<0.01）. After 7 d of treatment， both groups had lower plasma NT-proBNP， and the observation group had obviously lower plasma NT-proBNP as （136.2±28.1） ng/ml than （301.1±29.5） ng/ml in the control group. The difference was statistically significant （P<0.01）. Both groups had no statistically significant difference in plasma h-FABP before treatment （P>0.05）. After 4 d of treatment， the plasma h-FABP reached its peak value in the two groups， and the observation group had obviously lower plasma h-FABP as （19.15±3.37） ng/ml than （23.83±3.01） ng/ml in the control group. The difference was statistically significant （P<0.01）. After 7 d of treatment， both groups had lower plasma h-FABP， and the observation group had obviously lower plasma h-FABP as （2.09±0.41） ng/ml than （5.91±0.37） ng/ml in the control group. The difference was statistically significant （P<0.01）. Conclusion Application of ulinastatin for patients with large area burns during the perioperative period can relieve the injury of the myocardium and be beneficial to the recovery of the patients.endprint

【Key words】 Large area burns； Ulinastatin； Myocardium

大面積嚴(yán)重?zé)齻罂墒够颊咝墓δ芴幱谝种茽顟B(tài)， 心肌損害是一種常見的并發(fā)癥[1]。因此， 探討如何減輕大面積燒傷患者的心肌損傷一直是臨床研究的重點(diǎn)。本研究主要探討大面積燒傷患者圍手術(shù)期使用烏司他丁對(duì)心肌的保護(hù)作用， 尤其探討對(duì)心肌損害的敏感指標(biāo)NT-proBNP和h-FABP的影響。現(xiàn)報(bào)告如下。

1 資料與方法

1. 1 一般資料 選擇2012年10月～2016年10月進(jìn)行手術(shù)治療的大面積燒傷患者66例作為研究對(duì)象， 燒傷面積30%～80%體表總面積（TBSA）。排除標(biāo)準(zhǔn)：既往有心臟病病史（風(fēng)濕性心臟病、高血壓心臟病、冠心病等）、電復(fù)律史、電除顫史、急慢性腎衰竭和中毒史；惡性腫瘤；應(yīng)用糖皮質(zhì)激素及免疫抑制劑。將患……