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.	李静, 衡军. 严重肺挫伤并发呼吸窘迫综合征机制和治疗的研究进展. 中国急救医学, 2014, 34(6):550-554.
2.	秦龙飞, 王风华. 加味血府逐瘀汤治疗急性肺挫伤的临床分析.中国实验方剂学杂志, 2013, 19(7):333-335.
3.	陈喜云, 钮海弟, 徐善明, 等. 大剂量地塞米松联合乌司他丁治疗严重肺挫伤. 中国临床医学, 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.	张转, 孙建宏, 杨建军, 等. 精氨酸加压素在血管舒张性休克治疗中的进展. 国际麻醉学与复苏杂志, 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.	李辉, 主编. 现代胸外科急症学. 北京:人民军医出版社, 2006. 533.
9.	马翠英. 严重肺挫伤的护理. 现代护理, 2006, 12(5):433.
10.	贝政平, 何继永, 杨骏. 外科疾病诊断标准. 第2版. 北京:科学出版社, 2007. 425.
11.	曹祥, 严四军, 邓波荣, 等. 肺挫伤475例的临床诊断与治疗. 中国胸心血管外科临床杂志, 2012, 19(2):216-218.
12.	徐洋, 高晶, 孙兆瑞, 等. 创伤致ARDS 患者肺部循环异常的急救方法及临床效果观察. 临床急诊杂志, 2014, 15(12):725-727.
13.	韩冬, 陆士奇, 李静, 等. 严重肺挫伤患者血浆血管内皮生长因子的动态变化及其临床意义. 中国急救医学, 2013, 33(12):1103-1106.
14.	庄育田, 白士先, 孙继玲, 等. 血必净治疗严重肺挫伤效果分析. 中国综合临床, 2013, 29(7):720-723.
15.	韦春晖, 方世勇, 刘加庆, 等. 当归须散治疗急性肺挫伤的疗效分析. 中华创伤杂志, 2014, 30(5):423-425.
16.	肖波. 胸部创伤的放射学早期诊断价值. 中国实用医药, 2013, 8(31):23-24.
17.	王辉, 韩芳. 乌司他丁对多发伤患者炎症反应的抑制作用. 中国临床药理学杂志, 2013, 29(7):498-500.
18.	谢波, 薛松, 王维俊, 等. 乌司他丁在深低温停循环主动脉手术中的肺保护作用. 中国胸心血管外科临床杂志, 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. 李静, 衡军. 严重肺挫伤并发呼吸窘迫综合征机制和治疗的研究进展. 中国急救医学, 2014, 34(6):550-554.
2. 秦龙飞, 王风华. 加味血府逐瘀汤治疗急性肺挫伤的临床分析.中国实验方剂学杂志, 2013, 19(7):333-335.
3. 陈喜云, 钮海弟, 徐善明, 等. 大剂量地塞米松联合乌司他丁治疗严重肺挫伤. 中国临床医学, 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. 张转, 孙建宏, 杨建军, 等. 精氨酸加压素在血管舒张性休克治疗中的进展. 国际麻醉学与复苏杂志, 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. 李辉, 主编. 现代胸外科急症学. 北京:人民军医出版社, 2006. 533.
9. 马翠英. 严重肺挫伤的护理. 现代护理, 2006, 12(5):433.
10. 贝政平, 何继永, 杨骏. 外科疾病诊断标准. 第2版. 北京:科学出版社, 2007. 425.
11. 曹祥, 严四军, 邓波荣, 等. 肺挫伤475例的临床诊断与治疗. 中国胸心血管外科临床杂志, 2012, 19(2):216-218.
12. 徐洋, 高晶, 孙兆瑞, 等. 创伤致ARDS 患者肺部循环异常的急救方法及临床效果观察. 临床急诊杂志, 2014, 15(12):725-727.
13. 韩冬, 陆士奇, 李静, 等. 严重肺挫伤患者血浆血管内皮生长因子的动态变化及其临床意义. 中国急救医学, 2013, 33(12):1103-1106.
14. 庄育田, 白士先, 孙继玲, 等. 血必净治疗严重肺挫伤效果分析. 中国综合临床, 2013, 29(7):720-723.
15. 韦春晖, 方世勇, 刘加庆, 等. 当归须散治疗急性肺挫伤的疗效分析. 中华创伤杂志, 2014, 30(5):423-425.
16. 肖波. 胸部创伤的放射学早期诊断价值. 中国实用医药, 2013, 8(31):23-24.
17. 王辉, 韩芳. 乌司他丁对多发伤患者炎症反应的抑制作用. 中国临床药理学杂志, 2013, 29(7):498-500.
18. 谢波, 薛松, 王维俊, 等. 乌司他丁在深低温停循环主动脉手术中的肺保护作用. 中国胸心血管外科临床杂志, 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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