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.	邓宁,常为民,王春全,等.急性呼吸窘迫综合征患者血管外肺水的动态变化与预后的关系.中国呼吸与危重监护杂志,2014,13:528-531.
8.	骆勇,贾文钗,王征,等.血管外肺水指数和胸腔内血容积指数在严重肺部感染合并感染性休克患者液体管理中的意义.中国呼吸与危重监护杂志,2013,12:344-348.
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10.	杨春辉,王璐,唐建国,等,乌司他丁对重度脓毒症诱导的ALI/ARDS模型大鼠肺组织中蛋白C及活化蛋白C含量的影响.中国临床医学,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.	陈昊,张丽葳,林兆奋,等.不同剂量乌司他丁对急性肺损伤大鼠MMP-9等炎症因子调控的研究.中国医药导报,2011,8:15-18.
13.	王小伟,韦世奎.不同剂量乌司他丁治疗急性肺损伤的临床研究.医药与保健,2009,17:5l-52.
14.	梁瑜.不同剂量乌司他丁治疗严重脓毒血症患者疗效评价.河北医药,2013,35:2116-2117.
15.	许磊,郭东风,惠小平,等.乌司他丁对心肺复苏患者血液流变学影响及其预后的研究.中国血液流变学杂志,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. 邓宁,常为民,王春全,等.急性呼吸窘迫综合征患者血管外肺水的动态变化与预后的关系.中国呼吸与危重监护杂志,2014,13:528-531.
8. 骆勇,贾文钗,王征,等.血管外肺水指数和胸腔内血容积指数在严重肺部感染合并感染性休克患者液体管理中的意义.中国呼吸与危重监护杂志,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. 杨春辉,王璐,唐建国,等,乌司他丁对重度脓毒症诱导的ALI/ARDS模型大鼠肺组织中蛋白C及活化蛋白C含量的影响.中国临床医学,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. 陈昊,张丽葳,林兆奋,等.不同剂量乌司他丁对急性肺损伤大鼠MMP-9等炎症因子调控的研究.中国医药导报,2011,8:15-18.
13. 王小伟,韦世奎.不同剂量乌司他丁治疗急性肺损伤的临床研究.医药与保健,2009,17:5l-52.
14. 梁瑜.不同剂量乌司他丁治疗严重脓毒血症患者疗效评价.河北医药,2013,35:2116-2117.
15. 许磊,郭东风,惠小平,等.乌司他丁对心肺复苏患者血液流变学影响及其预后的研究.中国血液流变学杂志,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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