Effects of high dose Ulinastatin with lung protective ventilatory strategies on critical disease patients combined with acute lung injury/acute respiratory distress syndrome_Chinese Journal of Evidence-Based Medicine

Authors：

HUA Tianfeng , YIN Lu , LI Hui , ZHENG Yao , ZHANG Pingjie ,  YANG Min

The Second Affiliated Hospital of Anhui Medical University, Hefei, 230601, P.R.China;

Corresponding author：

YANG Min, Email: 512130761@qq.com

Keywords：

Ulinastatin; ALI/ARDS; PVPI; ELWI

DOI：

10.7507/1672-2531.201612096

Video：

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Objective To investigate the effects of high dose ulinastatin with lung protective ventilatory strategies on respiratory function and prognosis in critical disease patients combined with acute lung injury/acute respiratory distress syndrome. Methods Using retrospective analysis, we involved the critical disease patients combined with ALI/ARDS in ICU of The Second Affiliated Hospital of Anhui Medical University. According to whether they were treated with high dose ulinastatin with lung protective ventilatory strategies or not, the patients were divided into the treatment group and the control group. Then pulmonary vascular permeability index (PVPI), extravascular lung water index (EVLWI), oxygenation index, length of SIRS, length of stay in ICU and APACHE Ⅱ score were observed. Statistic analysis was conducted using SPSS 19.0 software. Results A total of 24 patients were included, 13 cases in the treatment group and 11 cases in the control group. After 72 h, PVPI (P=0.016), EVLWI (P=0.045), length of SIRS (P=0.002), length of stay in ICU (P=0.024) and APACHE Ⅱ score (P=0.002) decreased significantly, while oxygenation index (P=0.004) increased significantly in the treatment group compared with the control group. Conclusion High dose ulinastatin with lung protective ventilatory strategies decreased lung capillary permeability, reduced lung blood capillary leakage and extravascular lung water, resulted in the improvement of lung oxygenation function, decreased of length of stay in ICU and the improvement of prognosis in critical disease patients combined with acute lung injury/acute respiratory distress syndrome.

Citation： HUA Tianfeng, YIN Lu, LI Hui, ZHENG Yao, ZHANG Pingjie, YANG Min. Effects of high dose Ulinastatin with lung protective ventilatory strategies on critical disease patients combined with acute lung injury/acute respiratory distress syndrome. Chinese Journal of Evidence-Based Medicine, 2017, 17(4): 379-382. doi: 10.7507/1672-2531.201612096 Copy

1.	Azevedo LC, Park M, Salluh JI, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care, 2013, 17(2): R63.
2.	Mikkelsen ME, Shah CV, Meyer NJ, et al. The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis. Shock, 2013, 40(5): 375-381.
3.	Blank R, Napolitano LM. Epidemiology of ARDS and ALI. Crit Care Clin, 2011, 27(3): 439-458.
4.	Chambers J, Manley L, Nolen JE, et al. American lung association: lung disease data. New York: American Lung Association, 2008.
5.	Hager DN. Recent advances in the management of the acute respiratory distress syndrome. Clin Chest Med, 2015, 36(3): 481-496.
6.	急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006). 中华急诊医学杂志, 2007, 16(4): 343-349.
7.	Weiss CH, Baker DW, Weiner S, et al. Low tidal volume ventilation use in acute respiratory distress syndrome. Crit Care Med, 2016, 44(8): 1515-1522.
8.	岳茂奎, 刘芙蓉, 赵蕾, 等. 集束化治疗中/重度急性呼吸窘迫综合征的多中心临床研究. 中华危重病急救医学, 2015, 27(7): 601-605.
9.	Uemura K, Murakami Y, Hayashidani Y, et al. Randomized clinical trial to assess the efficacy of ulinastatin for postoperative pancreatitis following pancreaticoduodenectomy. J Surg Oncol, 2008, 98(5): 309-313.
10.	Cao YZ, Tu YY, Chen X, et al. Protective effect of Ulinastatin against murine models of sepsis: inhibition of TNF-α and IL-6 and augmentation of IL-10 and IL-13. Exp Toxicol Pathol, 2012, 64(6): 543-547.
11.	Inoue K, Takano H. Urinary trypsin inhibitor as a therapeutic option for endotoxin-related inflammatory disorders. Expert Opin Investig Drugs, 2010, 19(4): 513-520.
12.	Gao C, Liu Y, Ma L, et al. Protective effects of ulinastatin on pulmonary damage in rats following scald injury. Burns, 2012, 38(7): 1027-1034.
13.	胡马洪, 许秀娟, 金东, 等. 乌司他丁对 ARDS 肺血管内皮通透性的临床研究. 全科医学临床与教育, 2009, 7(3): 229-231.
14.	Leng YX, Yang SG, Song YH, 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.
15.	Koga Y, Fujita M, Tsuruta R, et al. Urinary trypsin inhibitor suppresses excessive superoxide anion radical generation in blood, oxidative stress, early inflammation, and endothelial injury in forebrain ischemia/reperfusion rats. Neurol Res, 2010, 32(9): 925-932.
16.	张国玉, 王春鲜, 王建星, 等. 乌司他丁对血管内皮细胞氧化应激损伤的保护作用及机制. 中国临床研究, 2016, 29(2): 193-198.
17.	Wang LP, Huang X, Kong GQ, et al. Ulinastatin attenuates pulmonary endothelial glycocalyx damage and inhibits endothelial heparanase activity in LPS-induced ARDS. Biochem Biophy Res Commun, 2016, 478(2): 669-675.
18.
19.	朱金源, 王晓红, 杨晓军, 等. 血管外肺水指数和肺血管通透性指数与急性呼吸窘迫综合征严重程度的相关性. 中华医学杂志, 2015, 95(19): 1463-1467.

1. Azevedo LC, Park M, Salluh JI, et al. Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study. Crit Care, 2013, 17(2): R63.
2. Mikkelsen ME, Shah CV, Meyer NJ, et al. The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis. Shock, 2013, 40(5): 375-381.
3. Blank R, Napolitano LM. Epidemiology of ARDS and ALI. Crit Care Clin, 2011, 27(3): 439-458.
4. Chambers J, Manley L, Nolen JE, et al. American lung association: lung disease data. New York: American Lung Association, 2008.
5. Hager DN. Recent advances in the management of the acute respiratory distress syndrome. Clin Chest Med, 2015, 36(3): 481-496.
6. 急性肺损伤/急性呼吸窘迫综合征诊断和治疗指南(2006). 中华急诊医学杂志, 2007, 16(4): 343-349.
7. Weiss CH, Baker DW, Weiner S, et al. Low tidal volume ventilation use in acute respiratory distress syndrome. Crit Care Med, 2016, 44(8): 1515-1522.
8. 岳茂奎, 刘芙蓉, 赵蕾, 等. 集束化治疗中/重度急性呼吸窘迫综合征的多中心临床研究. 中华危重病急救医学, 2015, 27(7): 601-605.
9. Uemura K, Murakami Y, Hayashidani Y, et al. Randomized clinical trial to assess the efficacy of ulinastatin for postoperative pancreatitis following pancreaticoduodenectomy. J Surg Oncol, 2008, 98(5): 309-313.
10. Cao YZ, Tu YY, Chen X, et al. Protective effect of Ulinastatin against murine models of sepsis: inhibition of TNF-α and IL-6 and augmentation of IL-10 and IL-13. Exp Toxicol Pathol, 2012, 64(6): 543-547.
11. Inoue K, Takano H. Urinary trypsin inhibitor as a therapeutic option for endotoxin-related inflammatory disorders. Expert Opin Investig Drugs, 2010, 19(4): 513-520.
12. Gao C, Liu Y, Ma L, et al. Protective effects of ulinastatin on pulmonary damage in rats following scald injury. Burns, 2012, 38(7): 1027-1034.
13. 胡马洪, 许秀娟, 金东, 等. 乌司他丁对 ARDS 肺血管内皮通透性的临床研究. 全科医学临床与教育, 2009, 7(3): 229-231.
14. Leng YX, Yang SG, Song YH, 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.
15. Koga Y, Fujita M, Tsuruta R, et al. Urinary trypsin inhibitor suppresses excessive superoxide anion radical generation in blood, oxidative stress, early inflammation, and endothelial injury in forebrain ischemia/reperfusion rats. Neurol Res, 2010, 32(9): 925-932.
16. 张国玉, 王春鲜, 王建星, 等. 乌司他丁对血管内皮细胞氧化应激损伤的保护作用及机制. 中国临床研究, 2016, 29(2): 193-198.
17. Wang LP, Huang X, Kong GQ, et al. Ulinastatin attenuates pulmonary endothelial glycocalyx damage and inhibits endothelial heparanase activity in LPS-induced ARDS. Biochem Biophy Res Commun, 2016, 478(2): 669-675.
18.
19. 朱金源, 王晓红, 杨晓军, 等. 血管外肺水指数和肺血管通透性指数与急性呼吸窘迫综合征严重程度的相关性. 中华医学杂志, 2015, 95(19): 1463-1467.

Chinese Journal of Evidence-Based Medicine

Effects of high dose Ulinastatin with lung protective ventilatory strategies on critical disease patients combined with acute lung injury/acute respiratory distress syndrome

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