Changes of Extravascular Lung Water and Effects of Ulinastatin in Serious Septic Patients with ARDS_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

HeChao ¹ , HuangZengxiang ² , TaoYe ² , XuWen ² , XuXunke ² , JinZhu ² , WeiJiandong ² , ZhangJian ² ,  LiWenfang ¹ , LinZhaofen ¹

1. Emergency Department, Changzheng Hospital, Shanghai, 200003, China;
2. ;

Corresponding?author：

LiWenfang, Email: chzhedlwf@163.com

Keywords：

Acute respiratory distress syndrome; Ulinastatin; Extravascular lung water; Pulse indicator continuous cardiac output

DOI：

10.7507/1671-6205.2015071

Video：

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Objective To observe the level of extravascular lung water index (ELWI) in serious septic patients with ARDS,and the effects of ulinastatin (UTI) on ELWI. Methods A perspective control study was performed on 48 severe septic patients with ARDS from the emergency department and ICU in Shanghai Changzhen Hospital from January 2010 to December 2012. Pulse indicator continuous cardiac output (PICCO) technique was utilized for measuring ELWI. Meanwhile the oxygenation index (PaO₂/FiO₂) was detected. The patients were randomized as an UTI group (n=30) and a control group (n=18). Both groups received routine comprehensive treatments,and the UTI group additionally received 30 000 units/kg UTI intravenous drip 4 times a day for continuous 3 days. The PaO₂/FiO₂,ELWI,Murray lung injury score,APACHEⅡ score,SOFA score and 28-day mortality were determined. Results The APACHE Ⅱ score,Murray and SOFA score had no statistical difference between the UTI group and the control group before treatment (P>0.05),and decreased significantly after 4 and 7 days of treatment in both groups compared with those before treatment (P<0.05). There were varying degrees of PaO₂/FiO₂ decrease and ELWI increase before treatment in both groups with no significant difference between two groups (P>0.05). After treatment,the PaO₂/FiO₂ increased and ELWI decreased in both groups,and the UTI group had better PaO₂/FiO₂ and ELWI than the control group (P<0.05). The difference in 28-day mortality between the UTI group and the control group was statistically significant (10.0% vs. 33.3%,P<0.05). Conclusions Severe septic patients with ARDS are all complicated with ELWI increase. Routine therapy combined with UTI can decrease ELWI,improve clinical symptoms,and decrease 28-day mortality.

Citation： HeChao, HuangZengxiang, TaoYe, XuWen, XuXunke, JinZhu, WeiJiandong, ZhangJian, LiWenfang, LinZhaofen. Changes of Extravascular Lung Water and Effects of Ulinastatin in Serious Septic Patients with ARDS. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(3): 291-294. doi: 10.7507/1671-6205.2015071 Copy

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5.	Martín Vivas A,Saboya Sánchez S,Patiňo Rodríguez M,et al. Hemodynamic monitoring:PiCCO system. Enferm Intensiva,2008,19:132-140.
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7.	鄧寧,常為民,王春全,等.急性呼吸窘迫綜合征患者血管外肺水的動態變化與預后的關系.中國呼吸與危重監護雜志,2014,13:528-531.
8.	駱勇,賈文釵,王征,等.血管外肺水指數和胸腔內血容積指數在嚴重肺部感染合并感染性休克患者液體管理中的意義.中國呼吸與危重監護雜志,2013,12:344-348.
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11.	Nakatani K,Takeshita S,Tsujimoto H,et al. Inhibitory effect of serine protease inhibitors on neutrophil-mediated endothelial cell injury. J Leukoc Biol,2001,69:241-247.
12.	陳昊,張麗葳,林兆奮,等.不同劑量烏司他丁對急性肺損傷大鼠MMP-9等炎癥因子調控的研究.中國醫藥導報,2011,8:15-18.
13.	王小偉,韋世奎.不同劑量烏司他丁治療急性肺損傷的臨床研究.醫藥與保健,2009,17:5l-52.
14.	梁瑜.不同劑量烏司他丁治療嚴重膿毒血癥患者療效評價.河北醫藥,2013,35:2116-2117.
15.	許磊,郭東風,惠小平,等.烏司他丁對心肺復蘇患者血液流變學影響及其預后的研究.中國血液流變學雜志,2007,17:148-251.
16.	Tani T,Aoki H,Yoshioka T,et al. Treatment of septic shock with a protease inhibitor in a canine model:a prospective,randomized,controlled trial. Crit Care Med,1993,21:925-930.

1. ?Burbeto PD,Seam N,Groot S,et al. Rapid induction of autoantibodies during ARDS and septic shock. J Transl Med,2010,8:97.
2. Papathanassoglou ED,Movnihan JA,Dafni O,et al. Association of proinflammatory molecules with apoptotic markers and survival in critically ill multiple organ dysfunction patients. Biol Res Nurs,2003,5:129-141.
3. Steinberg J,Halter J,Schiller HJ,et al. Metalloproteinase inhibition reduces lung injury and improves survival after cecal ligation and puncture in rats. J Surg Res,2003,111:185-195.
4. Kuzkov VV,Kirov MY,Sovershaev MA,et al. Extravascular lung water determined with single transpulmonary thermodilution correlates with the severity of sepsis-induced acute lung injury. Crit Care Med,2006,34:1647-1653.
5. Martín Vivas A,Saboya Sánchez S,Patiňo Rodríguez M,et al. Hemodynamic monitoring:PiCCO system. Enferm Intensiva,2008,19:132-140.
6. Szakmany T,Heigl P,Molnar Z. Correlation between extravascular lung water and oxygenation in ALI/ARDS patients in septic shock:possible role in the development of atelectasis? Anaesth Intensive Care,2004,32:196-201.
7. 鄧寧,常為民,王春全,等.急性呼吸窘迫綜合征患者血管外肺水的動態變化與預后的關系.中國呼吸與危重監護雜志,2014,13:528-531.
8. 駱勇,賈文釵,王征,等.血管外肺水指數和胸腔內血容積指數在嚴重肺部感染合并感染性休克患者液體管理中的意義.中國呼吸與危重監護雜志,2013,12:344-348.
9. Hirotaka T,Isobe L,Kenji Okajima,et al. Inhibition of tumor necrosis factor production by urinary trypsin inhibitor. International Congress.Series,2003,12:69-74.
10. 楊春輝,王璐,唐建國,等,烏司他丁對重度膿毒癥誘導的ALI/ARDS模型大鼠肺組織中蛋白C及活化蛋白C含量的影響.中國臨床醫學,2013,20:447-449.
11. Nakatani K,Takeshita S,Tsujimoto H,et al. Inhibitory effect of serine protease inhibitors on neutrophil-mediated endothelial cell injury. J Leukoc Biol,2001,69:241-247.
12. 陳昊,張麗葳,林兆奮,等.不同劑量烏司他丁對急性肺損傷大鼠MMP-9等炎癥因子調控的研究.中國醫藥導報,2011,8:15-18.
13. 王小偉,韋世奎.不同劑量烏司他丁治療急性肺損傷的臨床研究.醫藥與保健,2009,17:5l-52.
14. 梁瑜.不同劑量烏司他丁治療嚴重膿毒血癥患者療效評價.河北醫藥,2013,35:2116-2117.
15. 許磊,郭東風,惠小平,等.烏司他丁對心肺復蘇患者血液流變學影響及其預后的研究.中國血液流變學雜志,2007,17:148-251.
16. Tani T,Aoki H,Yoshioka T,et al. Treatment of septic shock with a protease inhibitor in a canine model:a prospective,randomized,controlled trial. Crit Care Med,1993,21:925-930.

Chinese Journal of Respiratory and Critical Care Medicine

Changes of Extravascular Lung Water and Effects of Ulinastatin in Serious Septic Patients with ARDS

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