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

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3.	Blank R, Napolitano LM. Epidemiology of ARDS and ALI. Crit Care Clin, 2011, 27(3): 439-458.
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6.	急性肺損傷/急性呼吸窘迫綜合征診斷和治療指南(2006). 中華急診醫學雜志, 2007, 16(4): 343-349.
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8.	岳茂奎, 劉芙蓉, 趙蕾, 等. 集束化治療中/重度急性呼吸窘迫綜合征的多中心臨床研究. 中華危重病急救醫學, 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.	胡馬洪, 許秀娟, 金東, 等. 烏司他丁對 ARDS 肺血管內皮通透性的臨床研究. 全科醫學臨床與教育, 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.	張國玉, 王春鮮, 王建星, 等. 烏司他丁對血管內皮細胞氧化應激損傷的保護作用及機制. 中國臨床研究, 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, 王曉紅, 楊曉軍, 等. 血管外肺水指數和肺血管通透性指數與急性呼吸窘迫綜合征嚴重程度的相關性. 中華醫學雜志, 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. 急性肺損傷/急性呼吸窘迫綜合征診斷和治療指南(2006). 中華急診醫學雜志, 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, 劉芙蓉, 趙蕾, 等. 集束化治療中/重度急性呼吸窘迫綜合征的多中心臨床研究. 中華危重病急救醫學, 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. 胡馬洪, 許秀娟, 金東, 等. 烏司他丁對 ARDS 肺血管內皮通透性的臨床研究. 全科醫學臨床與教育, 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. 張國玉, 王春鮮, 王建星, 等. 烏司他丁對血管內皮細胞氧化應激損傷的保護作用及機制. 中國臨床研究, 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, 王曉紅, 楊曉軍, 等. 血管外肺水指數和肺血管通透性指數與急性呼吸窘迫綜合征嚴重程度的相關性. 中華醫學雜志, 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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