Clinical Efficacy of Ulinastatin Combined with Low-dose Arginine Vasopressin for Severe Pulmonary Contusion: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LINHong-sheng ¹ , LIJian-qiu ² , DUXiao-yang ²

1. Department of Thoracic Surgery, Shajing Hospital Affiliated to Guangzhou Medical University, Shenzheng 518104 Guangdong, P. R. China;
2. Department of ICU, Shajing Hospital Affiliated to Guangzhou Medical University, Shenzheng 518104 Guangdong, P. R. China;

Corresponding?author：

LINHong-sheng, Email: linhongshen3486@126.com

Keywords：

Severe pulmonary contusion; Ulinastatin; Arginine vasopressin; Combined treatment

DOI：

10.7507/1007-4848.20150190

Video：

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Objective To observe the clinical efficacy of ulinastatin combined with low-dose arginine vasopressin in treating severe pulmonary contusion. Method Sixty patients with severe pulmonary contusion were enrolled in our hospital between April 2012 to June 2014 year. All the patients were randomly divided into three groups. They were respectively defined as a routine treatment group (group A, n=20), an ulinastatin treatment group (group B, n=20), and a combined treatment group (group C, n=20). The respiratory frequency (RR), oxygenation index, partial pressure of carbon dioxide (PaCO₂), the change of chest X-ray and the change of serum interleukin-6 (IL-6), IL-8 levels were compared among three groups before and after therapy. Result The respiration frequency(RR) and the concentration of serum IL-6, IL-8 levels were decreased in the group C before and after treatment with statistical differences (P=0.000, 0.000, 0.000). PaO₂/FiO₂ and PaCO₂ were significantly increased in the group C before and after treatment (P=0.000, 0.000). After treatment for 7 d, the respiration frequency (RR) and the concentration of serum IL-6, IL-8 of patients in the group B decreased significantly compared with those in the group A (P=0.000, 0.043, 0.000). While PaO₂/FiO₂, PaCO 2 and the score of chest X-ray increased significantly in the group B (P=0.010, 0.000, 0.000). Compared with those in the group B, RR and the concentration of serum IL-6, IL-8 of patients in the group C decreased significantly (P=0.000, 0.045, 0.000), while PaO₂/FiO₂, PaCO₂ and the score of chest X-ray increased significantly (P=0.043, 0.010, 0.001). Conclusion Ulinastatin combined with low-dose arginine vasopressin shows obvious effects in the patients with severe pulmonary contusion. And its therapeutical effects are better than that of the other two treatment options.

Citation： LINHong-sheng, LIJian-qiu, DUXiao-yang. Clinical Efficacy of Ulinastatin Combined with Low-dose Arginine Vasopressin for Severe Pulmonary Contusion: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(8): 760-764. doi: 10.7507/1007-4848.20150190 Copy

1.	李靜, 衡軍. 嚴重肺挫傷并發呼吸窘迫綜合征機制和治療的研究進展. 中國急救醫學, 2014, 34(6):550-554.
2.	秦龍飛, 王風華. 加味血府逐瘀湯治療急性肺挫傷的臨床分析.中國實驗方劑學雜志, 2013, 19(7):333-335.
3.	陳喜云, 鈕海弟, 徐善明, 等. 大劑量地塞米松聯合烏司他丁治療嚴重肺挫傷. 中國臨床醫學, 2011, 18(1):62-63, 65.
4.	Yu XL, Yang SG, Yao GQ, et al. Ulinastatin for acute lung injury and acute respiratory distress syndrome:A systematic review and meta-analysis. World J Crit Care Med, 2014, 3(1):34-41.
5.	張轉, 孫建宏, 楊建軍, 等. 精氨酸加壓素在血管舒張性休克治療中的進展. 國際麻醉學與復蘇雜志, 2009, 30(5):469-472.
6.	Mastropaolo M, Zizzo MG, Auteri M, et al. Arginine vasopressin, via activation of post-junctional V1 receptors, induces contractile effects in mouse distal colon. Regul Pept, 2013, 187(10):29-34.
7.	Holt NF, Haspel KL. Vasopressin:A review of therapeutic applications. J Cardiothorac Vasc, 2010, 24(2):330-347.
8.	李輝, 主編. 現代胸外科急癥學. 北京:人民軍醫出版社, 2006. 533.
9.	馬翠英. 嚴重肺挫傷的護理. 現代護理, 2006, 12(5):433.
10.	貝政平, 何繼永, 楊駿. 外科疾病診斷標準. 第2版. 北京:科學出版社, 2007. 425.
11.	曹祥, 嚴四軍, 鄧波榮, 等. 肺挫傷475例的臨床診斷與治療. 中國胸心血管外科臨床雜志, 2012, 19(2):216-218.
12.	徐洋, 高晶, 孫兆瑞, 等. 創傷致ARDS 患者肺部循環異常的急救方法及臨床效果觀察. 臨床急診雜志, 2014, 15(12):725-727.
13.	韓冬, 陸士奇, 李靜, 等. 嚴重肺挫傷患者血漿血管內皮生長因子的動態變化及其臨床意義. 中國急救醫學, 2013, 33(12):1103-1106.
14.	莊育田, 白士先, 孫繼玲, 等. 血必凈治療嚴重肺挫傷效果分析. 中國綜合臨床, 2013, 29(7):720-723.
15.	韋春暉, 方世勇, 劉加慶, 等. 當歸須散治療急性肺挫傷的療效分析. 中華創傷雜志, 2014, 30(5):423-425.
16.	肖波. 胸部創傷的放射學早期診斷價值. 中國實用醫藥, 2013, 8(31):23-24.
17.	王輝, 韓芳. 烏司他丁對多發傷患者炎癥反應的抑制作用. 中國臨床藥理學雜志, 2013, 29(7):498-500.
18.	謝波, 薛松, 王維俊, 等. 烏司他丁在深低溫停循環主動脈手術中的肺保護作用. 中國胸心血管外科臨床雜志, 2010, 17(5):428-430.
19.	Huang N, Wang F, Wang YW, et al. Ulinastatin improves survival of septic mice by suppressing inflammatory response and lymphocyte apoptosis. J Surg Res, 2013, 182(2):296-302.
20.	Xu CE, Zou CW, Zhang MY, et al. Effects of high-dose ulinastatin on inflammatory response and pulmonary function in patients with type-A aortic dissection after cardiopulmonary bypass under deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth, 2013, 27(3):479-484.
21.	Li F, Zhang H, Xu KY, et al. Role of the chemokine fractalkine in a rat model of acute necrotizing pancreatitis and the interventional effect of ulinastatin. Arch Iran Med, 2013, 16(2):83-87.
22.	Liu L, Tian K, Xue M, et al. Small doses of arginine vasopressin in combination with norepinephrine "buy" time for definitive treatment for uncontrolled hemorrhagic shock in rats. Shock, 2013, 40(5):398-406.
23.	Friederike U, Diederich S, Erling B, et al. Arginine vasopressindependent and AVP-independent mechanisms of renal fluid absorption during thirsting despite glucocorticoid-mediated vasopressin suppression. Clin Endocrinol, 2013, 78(3):431-437.

1. 李靜, 衡軍. 嚴重肺挫傷并發呼吸窘迫綜合征機制和治療的研究進展. 中國急救醫學, 2014, 34(6):550-554.
2. 秦龍飛, 王風華. 加味血府逐瘀湯治療急性肺挫傷的臨床分析.中國實驗方劑學雜志, 2013, 19(7):333-335.
3. 陳喜云, 鈕海弟, 徐善明, 等. 大劑量地塞米松聯合烏司他丁治療嚴重肺挫傷. 中國臨床醫學, 2011, 18(1):62-63, 65.
4. Yu XL, Yang SG, Yao GQ, et al. Ulinastatin for acute lung injury and acute respiratory distress syndrome:A systematic review and meta-analysis. World J Crit Care Med, 2014, 3(1):34-41.
5. 張轉, 孫建宏, 楊建軍, 等. 精氨酸加壓素在血管舒張性休克治療中的進展. 國際麻醉學與復蘇雜志, 2009, 30(5):469-472.
6. Mastropaolo M, Zizzo MG, Auteri M, et al. Arginine vasopressin, via activation of post-junctional V1 receptors, induces contractile effects in mouse distal colon. Regul Pept, 2013, 187(10):29-34.
7. Holt NF, Haspel KL. Vasopressin:A review of therapeutic applications. J Cardiothorac Vasc, 2010, 24(2):330-347.
8. 李輝, 主編. 現代胸外科急癥學. 北京:人民軍醫出版社, 2006. 533.
9. 馬翠英. 嚴重肺挫傷的護理. 現代護理, 2006, 12(5):433.
10. 貝政平, 何繼永, 楊駿. 外科疾病診斷標準. 第2版. 北京:科學出版社, 2007. 425.
11. 曹祥, 嚴四軍, 鄧波榮, 等. 肺挫傷475例的臨床診斷與治療. 中國胸心血管外科臨床雜志, 2012, 19(2):216-218.
12. 徐洋, 高晶, 孫兆瑞, 等. 創傷致ARDS 患者肺部循環異常的急救方法及臨床效果觀察. 臨床急診雜志, 2014, 15(12):725-727.
13. 韓冬, 陸士奇, 李靜, 等. 嚴重肺挫傷患者血漿血管內皮生長因子的動態變化及其臨床意義. 中國急救醫學, 2013, 33(12):1103-1106.
14. 莊育田, 白士先, 孫繼玲, 等. 血必凈治療嚴重肺挫傷效果分析. 中國綜合臨床, 2013, 29(7):720-723.
15. 韋春暉, 方世勇, 劉加慶, 等. 當歸須散治療急性肺挫傷的療效分析. 中華創傷雜志, 2014, 30(5):423-425.
16. 肖波. 胸部創傷的放射學早期診斷價值. 中國實用醫藥, 2013, 8(31):23-24.
17. 王輝, 韓芳. 烏司他丁對多發傷患者炎癥反應的抑制作用. 中國臨床藥理學雜志, 2013, 29(7):498-500.
18. 謝波, 薛松, 王維俊, 等. 烏司他丁在深低溫停循環主動脈手術中的肺保護作用. 中國胸心血管外科臨床雜志, 2010, 17(5):428-430.
19. Huang N, Wang F, Wang YW, et al. Ulinastatin improves survival of septic mice by suppressing inflammatory response and lymphocyte apoptosis. J Surg Res, 2013, 182(2):296-302.
20. Xu CE, Zou CW, Zhang MY, et al. Effects of high-dose ulinastatin on inflammatory response and pulmonary function in patients with type-A aortic dissection after cardiopulmonary bypass under deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth, 2013, 27(3):479-484.
21. Li F, Zhang H, Xu KY, et al. Role of the chemokine fractalkine in a rat model of acute necrotizing pancreatitis and the interventional effect of ulinastatin. Arch Iran Med, 2013, 16(2):83-87.
22. Liu L, Tian K, Xue M, et al. Small doses of arginine vasopressin in combination with norepinephrine "buy" time for definitive treatment for uncontrolled hemorrhagic shock in rats. Shock, 2013, 40(5):398-406.
23. Friederike U, Diederich S, Erling B, et al. Arginine vasopressindependent and AVP-independent mechanisms of renal fluid absorption during thirsting despite glucocorticoid-mediated vasopressin suppression. Clin Endocrinol, 2013, 78(3):431-437.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Efficacy of Ulinastatin Combined with Low-dose Arginine Vasopressin for Severe Pulmonary Contusion: A Randomized Controlled Trial

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