乌司他丁对全身炎症反应综合征疗效的临床研究

目的:研究乌司他丁对全身炎症反应综合征(SIRS)患者体内炎症介质的影响。方法:将入选的78例SIRS患者随即分为2组,治疗组在对照组基础上加用乌司他丁250 kU静脉注射,每日2次,连用5天。观察患者体内炎症介质的水平变化。结果:治疗组治疗后炎症介质改善情况均明显优于对照组,治疗前后自身对照差异有显著性(P<0.05)。结论:乌司他丁可明显减轻SIRS患者细胞免疫抑制程度,增强细胞免疫功能,从而改善患者的预后。     

乌司他丁对严重烧伤患者肾脏功能的保护作用初探

目的研究乌司他丁对严重烧伤患者肾脏功能的保护作用。方法26例重度烧伤患者,随机分为治疗组和对照组,对照组予以常规治疗,治疗组在对照组治疗的基础上加用乌司他丁,分别于烧伤后第2天和第7天采集标本做血清尿素氮(BUN)、肌酐(Cr)、尿微量蛋白(UMA)、尿N-乙酰氨基葡萄糖甘酶(NAG)测定,观察对照组和治疗组各项指标差别。结果两组之间第7天各指标测定结果之间比较差异有统计学意义(P<0.05)。结论乌司他丁对严重烧伤患者的肾脏功能具有保护作用。     

乌司他丁对脂多糖诱导大鼠腹膜间皮细胞IL-15、IL-6表达的影响

目的：观察乌司他丁（UTI）对脂多糖（LPS）作用下大鼠腹膜间皮细胞（RPMC）白细胞介素-15（IL-15）、白细胞介素-6（IL-6）表达的影响。方法：行RPMC的原代和传代培养,经鉴定后第3代用于实验。随机分组（1）正常对照组;（2）不同浓度脂多糖组（1、10、100mg/L）;（3）不同时间组：10mg/LLPS作用于RPMC3、6、12、24h;（4）10mg/LLPS＋乌司他丁组（160、320、640U/ml）作用12h;实时定量PCR法测IL-15mRNA的表达;ELISA法检测细胞培养上清液中IL-15、IL-6的表达。结果：脂多糖可刺激RPMC的IL-15mRNA及蛋白的表达增高且在12h内呈时间剂量依赖性（P〈0.05）;脂多糖诱导RPMCIL-6的蛋白表达增高,在12h内呈时间剂量依赖性（P〈0.05）;乌司他丁能显著降低脂多糖所致的腹膜间皮细胞IL-15、IL-6的表达（P〈0.05）。结论：脂多糖可上调PMCIL-15、IL-6的表达,乌司他丁可抑制脂多糖所致的IL-15、IL-6过度表达,以预防或延缓腹膜炎的发生与发展。     

乌司他丁对严重烧伤小型猪肠黏膜损伤的影响

目的探讨蛋白酶抑制剂乌司他丁(Ulinastatin,UTI)对大面积烧伤后早期炎性介质、氧自由基产生和肠黏膜通透性改变的保护作用. 方法贵州三系雄性小型猪12只,造成背部35%TBSAⅢ度烧伤模型, 随机分为烧伤对照组(A组,6只)、UTI治疗组(B组,6只).B组动物于伤后1 h给予UTI 5 000 U/kg,缓慢静脉滴入;A组动物给予等量等渗盐水,3次/d,直至动物处死.分别于动物烧伤前(A、B两组各随机选取4只动物抽取静脉血作为正常对照)、伤后6、24、48、72 h抽血检测血清肿瘤坏死因子α(TNFα)、白细胞介素6(IL-6)、丙二醛(MDA)、超氧化物歧化酶(SOD)、血清二胺氧化酶(DAO)、D-乳酸含量. 结果伤后6 h,各组动物血清TNFα含量较伤前显著升高,尤以A组明显,高峰为伤后24 h,随后呈下降趋势.B组各时相点TNFα含量均低于A组,差异有显著性意义(P<0.05). IL-6的改变与TNF-α基本一致.A组动物伤后6～72 h血清MDA较伤前显著升高,SOD消耗明显增多.B组各时相点MDA含量均低于A组,SOD消耗明显减少,两组比较差异有显著性意义(P<0.05).伤后小肠黏膜屏障功能受损明显,血清DAO活性及D-乳酸含量显著升高.B组肠道功能明显改善,功能特异性酶含量明显减少. 结论 UTI能显著抑制过度的炎性反应,减少氧自由基释放,降低SOD消耗,从而减轻对肠黏膜屏障的损伤和肠通透性增高的程度.     

乌司他丁对手术患者免疫功能的影响

乌司他丁 (ＵＴＩ)是一种存在于人尿中的蛋白酶抑制剂。临床应用过程中 ,ＵＴＩ显示了对胰腺炎、急性循环障碍等疾病良好的治疗效果[1 ,2 ] 。本研究旨在观察ＵＴＩ用于大中型手术对机体促炎症细胞因子水平的影响。一、材料与方法1 .研究对象 :我院自 2 0 0 1年 1月～2 0 0 1年 9月行大中型手术的患者 30例 ,其中男 1 7例 ,女 1 3例 ,年龄 32～ 65岁 ,平均年龄 45岁。手术术式包括食道贲门血管离断术、胰十二指肠吻合术、肝脏部分切除术、胃癌根治术、肺叶切除术、食道癌根治术等。1 .方法 :将 30例患者随机分为两组 ,其中实验组 1 8例 ,对…     

乌司他丁对急性胰腺炎患者炎性细胞因子的调节作用

目的 探讨乌司他丁（UTI）治疗急性胰腺炎的作用机制和f临床疗效。方法将52例急性胰腺炎患者采用随机数字表法分为UTI组和对照组,每组各26例。对照组予以禁食、制酸、胃肠减压、生长抑素、抗感染及营养支持等治疗。UTI组在对照组基础上,给予UTI10万U静脉滴注,2次,d,共5d。结果治疗前,两组白细胞介素（IL）-6、IL-8、肿瘤坏死因子（TNFF）-α含量基本一致（P〉0．05）;治疗后,UTI组IL-6、IL．8和TNF-α下降速度均明显快于对照组（P〈0．05）。UTI组痊愈率65．4％（17／26）,明显高于对照组的34．6％（9／26）（P〈0．01）;UTI组痊愈率＋显效率为92．3％（24／26）,明显高于对照组的76．9％（20／26）（P〈0．01）。结论UTI对急性胰腺炎患者IL-6、IL-8、TNF-α的分泌、释放有一定的调节作用,治疗急性胰腺炎临床疗效确切,有一定的临床推广价值。     

乌司他丁对全身炎性反应综合征主要炎性介质的调节作用

许多感染和非感染因素可以导致机体的一个类似的生理病理过程，该过程涉及多种炎性细胞（中性粒细胞，单核一巨噬细胞，淋巴细胞等）和炎性介质，被称作全身炎性反应综合征（SIRS），乌司他丁是一种广谱的胰蛋白酶抑制剂，大量临床研究已证实它在感染，肿瘤，手术、休克等方面对心、肺、肝、脑、肾等脏器有很好的保护作用，现在认为这主要与其对全身炎性反应综合征的抑制有关。它可以下调促炎性因子-TNF-α，IL-1，IL-6，IL-8及核因子-KB、黏附分子、C-反应蛋白，并同时上调抗炎性因子-IL-10，1L-4。减轻全身炎性反应，防止多脏器功能障碍综合征（MODS）的发生。     

乌司他丁对骨科高龄患者手术后肾功能的影响

目的观察骨科高龄患者手术期应用乌司他丁对肾功能的保护作用。方法选择同期32例骨科高龄手术患者，年龄70～86岁，随机分为治疗组（A组）和对照组（B组），治疗组（A组）在对照组（B组）治疗的基础上加用乌司他丁注射液，分别于手术当日、手术后5天内，每8小时静注乌司他丁10万单位．溶于20ml生理盐水；测定麻醉前、术毕、术后1、3、5、7天血清肌肝（Scr）、尿素氮（BuN）及尿液中N-乙酰氨基葡萄糖糖苷酶（NAG）、r-谷氨酸转肽酶（r—GTP）、al微球蛋白（al—MG）和尿液量水平。结果手术前组间血清Cr、BUN、NAG、r—GTP、al—MG的水平差异均无统计学意义（P〉0．05）。与治疗组（A组）比较，对照组（B组）术后NAG，r—GTP、al—MG在各时点明显升高（P〈0．01）。血清、Cr、BUN、在第1-3天明显升高（P〈0．05）。两组间排尿量无明显差异，但从每分钟输液量和分钟尿量的比值（排尿量／输液量）来看，在治疗组（A组）中该比值较高（P〈0．05）。结论骨科高龄患者围手术期应用乌司他丁对肾功能具有积极的保护作用。     

乌司他丁对心脏直视手术患者围术期血清呼吸指数和白细胞介素-6的影响

目的 探讨乌司他丁对心脏直视手术患者围术期血清呼吸指数(RI)和白细胞介素-6(IL-6)水平的影响.方法 28例择期瓣膜置换术患者随机均分为乌司他丁组(Ⅰ组)和对照组(Ⅱ组).分别测定中心静脉开放后(T1)、心肺转流(CPB)前即刻(T2),主动脉开放即刻(T3)、1 h(T4),2h(T5)、18 h(T6)6个时点血清RI和IL-6.结果 与T1时相比,T2时Ⅱ组IL-6明显升高(P<0.05),亦明显升高Ⅰ组(P<0.05).与T1时相比,T2、T4～T6时两组RI均明显升高(P<0.05),T5时Ⅱ组明显高于Ⅰ组(P<0.05).结论 乌司他丁能抑制IL-6释放,起到一定的肺保护作用.     

术中调节全身炎性反应对预防性镇痛的影响

目的 观察老年骨科患者术中使用乌司他丁调节全身炎性反应对预防性镇痛的影响.方法 80例老年骨科患者利用随机数字表及随机数余数分组方法被随机分入全麻+乌司他丁组(A组)、全麻+硬膜外麻醉组(B组)、全麻+乌司他丁复合硬膜外麻醉组(C组)、或单纯全麻组(D组).A组在切皮前予乌司他丁20万U,然后以20万U/h持续泵入至手...     

开放性骨折感染的临床研究

目的 :明确Ⅱ型及Ⅲ型开放骨折病人SIRS持续时间、预防应用抗生素与伤口感染率之间的关系 ,指导临床合理应用抗生素、降低伤口感染率。 方法 :回顾性分析 2 11个部位Ⅱ型及Ⅲ型开放骨折的临床资料 ,t′检验比较感染与非感染伤口SIRS持续时间 ,χ2 检验比较SIRS消失前、后停用抗生素的伤口感染率 ,分析感染伤口的细菌培养结果。 结果 :感染伤口的SIRS持续时间较非感染伤口的SIRS持续时间长 (P <0 0 5 ) ;SIRS消失后停用抗生素较SIRS消失前停用抗生素的伤口感染率低 (P <0 0 5 ) ;伤口感染的主要致病菌为革兰阴性杆菌。 结论 :SIRS持续时间是评估Ⅱ型及Ⅲ型开放骨折伤口感染和指导预防应用抗生素的较好方法。     

生态免疫肠内营养保护肠屏障功能的研究

目的探讨生态免疫肠内营养对全身炎症反应综合征(SIRS)大鼠肠屏障功能的保护作用。方法通过尾静脉注射脂多糖(LPS)建立SIRS大鼠模型,60只雄性SD大鼠随机分为4组(标准营养组、免疫增强组、生态营养组、生态免疫组),分别给予不同构成的肠内营养剂7d,观察各组大鼠血浆D-乳酸、二胺氧化酶(DAO)以及尿乳果糖/甘露醇(L/M)比值的动态变化。结果治疗7d后,生态营养组大鼠血浆D-乳酸水平明显低于标准营养组和免疫增强组(P<0.05),但这3组均高于生态免疫组3倍或以上(P<0.01)。血浆DAO水平标准营养组显著高于其他3组(P<0.01)。注射LPS后第1天起,各组大鼠尿液L/M比值均有大幅升高,至第6天回落到注射前水平。第1天时生态免疫组尿L/M比值低于其他3组(P<0.05),第3天时标准营养组尿L/M比值显著高于另外3组(P<0.01),至第6天各组已无明显差异。结论联合应用免疫增强营养素和生态制剂的生态免疫肠内营养能更有效地保护肠屏障功能。     

复合皮移植技术与富血小板血浆对烧伤后大面积瘢痕整复患者血清炎症因子水平及美观度的影响

目的:探讨复合皮移植技术与富血小板血浆(Platelet-rich plasma,PRP)对烧伤后大面积瘢痕整复患者血清炎症因子水平及美观度影响。方法:选取2016年11月-2018年11月笔者医院收治的96例烧伤后大面积瘢痕整复患者,按照随机数表法,分成对照组和研究组,每组各48例。其中对照组患者给予复合皮移植术,研究组患者采用PRP治疗,术后两组患者均定期换药。观察两组患者的创面愈合时间和临床疗效,观察两组患者炎症因子γ-干扰素(IFN-γ)、白细胞介素-2(IL-2)和白细胞介素-6(IL-6)治疗前后的变化情况,观察两组患者血管内皮生长因子(VEGF)和转化生长因子-β1(TGF-β1)的水平,采用OSAS瘢痕评价量表评价两组患者术后的美观度并比较两种方式的安全性。结果:研究组平均愈合时间明显短于对照组,且研究组总有效率明显高于对照组,差异有统计学意义(P<0.05)。治疗后,两组患者的IFN-γ和IL-2较治疗前均有明显改善,且研究组均明显高于对照组,差异有统计学意义(P<0.05)。研究组患者治疗后IL-6水平明显低于治疗前,差异有统计学意义(P<0.05)。研究组患者术后5d和10d血清中VEGT和TGF-β1的水平均明显高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的瘢痕平整度、瘢痕弹性程度和瘢痕颜色均有明显改善,研究组改善更明显,差异均有统计学意义(P<0.05)。研究组总不良反应发生率为4.17%明显低于对照组的18.75%,差异有统计学意义(P<0.05)。结论:PRP对烧伤后大面积瘢痕患者具有明显的临床优势,可加快创面愈合,有效降低血清炎症因子水平,减少瘢痕生长,安全性更高,值得临床推广。     

Development and validation of a novel nomogram for predicting systemic inflammatory response syndrome’s occurrence in patients undertaking flexible ureteroscopy

BackgroundThe occurrence of systemic inflammatory response syndrome (SIRS) is an early alert for sepsis after flexible ureteroscopy (fURS). Once sepsis occurs, it often leads to severe or fatal consequences. We aimed to identify SIRS patients preoperatively by developing and validating a feasible prognostic nomogram model based on retrospective cohort analysis.MethodsA total of 311 patients who underwent fURS in Dongguan Kanghua Hospital (Dongguan, China) between 2016 and 2020 were included and randomly divided into a primary cohort (n=219) and validation cohort (n=92). Single factor regression analysis was used to identify the primary cohort’s meaningful characters between SIRS and non-SIRS groups. Factors of the primary cohort were then identified by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram was built to execute the subsequent analysis using these factors. Finally, we analyzed and drew the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) curve to validate the prognostic value of the nomogram in calibration and discrimination.ResultsReview of the single regression analysis of characters in the primary cohort showed gender, stone burden, diabetes, neutrophil (N), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocytes ratio (LMR), urine-WBC, nitrite (Nit), urine culture, and surgery time as significant factors between the SIRS and non-SIRS groups (P<0.05). The LASSO regression analysis suggested NLR, PLR, and urine culture were substantial factors in predicting SIRS postoperatively, lambda.min and lambda.1se (standard error, SE) were 0.01491 and 0.0796. A nomogram built with the three factors showed good calibration and discrimination, with the Brier values 0.064 and 0.034 and the area under curve (AUC) values 0.897 (95% CI: 0.837–0.957) and 0.976 (95% CI: 0.947–1.000) in the primary and validation cohort, respectively. DCA demonstrated the nomogram was clinically useful, and the predict probability of SIRS’s occurrence was very close to the actual rate as the risk threshold increased by higher than 60% in clinical impact curve analysis.ConclusionsNLR, PLR, and urine culture were significantly related to the occurrence of SIRS’s after fURS. The nomogram with these three factors showed excellent calibration, discrimination, and clinical usefulness.     

心理护理对ICU重度烧伤清醒患者不良情绪的影响

分析对ICU重度烧伤清醒患者实施心理护理对其不良情绪的影响。方法 选取2020年2月-2021年2月在我院ICU接受治疗的100例重度烧伤清醒患者为研究对象,随机分为对照组和观察组,每组50例。对照组给予常规护理,观察组在对照组的基础上给予心理护理,比较两组护理满意度、情绪状态、心理健康情况及自我效能。结果 观察组护理满意度为96.00%,高于对照组的84.00%（P＜0.05）;观察组干预后POMS各项评分均高于对照组（P ＜0.05）;观察组干预后MHC-SF评分、GSES评分均高于对照组（P ＜0.05）。结论 对ICU重度烧伤清醒患者开展心理护理具有重要意义,不仅可以缓解患者的负面情绪,还能提升治疗效果,有利于改善患者的生活质量。     

Significant changes in the serum levels of IL-6, h-HGF, and type IV collagen 7S during the perioperative period of a hepatectomy: Relevance to SIRS

(Received for publication on Dec. 14, 1998; accepted on Nov. 11, 1999)     

Early detection of increased tumour necrosis factor alpha (TNFalpha) and soluble TNF receptor protein plasma levels after trauma reveals associations with the clinical course

BACKGROUND: The inflammatory response after trauma includes tumour necrosis factor alpha (TNFalpha) as pro-inflammatory cytokine. Furthermore, both soluble TNF receptor proteins (sTNF-R1 and sTNF-R2) were described to influence the post-traumatic inflammatory response and organ dysfunction. METHOD: From 47 trauma patients, blood samples were obtained at the scene of accident, at hospital admission, after 4 h, 12 h, and 24 h, and daily until day 6. Plasma levels of TNFalpha, sTNFR1 and sTNF-R2 were measured by enzyme immunoassay (EIA) and analysed comparing clinical parameters such as injury scores (ISS, AIS), development of multiple organ dysfunction syndrome (MODS) and/or systemic inflammatory response syndrome (SIRS), and outcome. RESULTS: Significant changes were observed in a time-dependent manner: TNFalpha and soluble TNF receptor levels were elevated compared to values of healthy persons. At 4 h after trauma, TNFalpha and sTNF-R2 showed an increase from initial values, which continued during the entire observation period. Severe trauma led to enhanced sTNF-R1 levels on scene and on hospital admission. Development of SIRS along with elevated sTNF-R1 began on scene and was present on admission, with increased sTNF-R2 from day 1 to day 4. MODS (until day 6) was preceded by increased sTNF-R2 levels on admission and up to 4 h after trauma. Outcome was associated neither with TNFalpha nor with soluble TNF receptor levels. CONCLUSION: Thus, in trauma patients, early post-traumatic MODS and SIRS coincide with increased levels of TNFalpha and TNF receptor proteins, revealing different, time-dependent changes. Hence, detection of TNFalpha and soluble TNF receptor proteins after trauma should pay regard to the time point of sampling.     

VSD技术联用表皮生长因子对深度烧伤创面愈合及炎症应激反应的影响

探讨VSD技术联用表皮生长因子对深度烧伤创面愈合及炎症应激反应的影响。方法 选取 2022年11月-2023年11月我院收治的深度烧伤患者62例,随机分为对照组和观察组,各31例。对照组应 用VSD技术与生理盐水冲洗治疗,观察组在对照组基础上应用表皮生长因子治疗,比较两组创面愈合 情况和炎症应激反应情况。结果 观察组创面愈合时间短于对照组,瘢痕生成数及感染数低于对照组 （P＜0.05）;观察组IL-1、TNF-α、E、NE、R水平低于对照组（P＜0.05）。结论 VSD技术结合表皮生 长因子能促进深度烧伤患者的创面愈合,提高创面愈合效果,减轻患者炎症应激反应。     

Acute Effect of Standard Heparin Versus Low Molecular Weight Heparin on Oxidative Stress and Inflammation in Hemodialysis Patients

Objective. Atherosclerotic cardiovascular diseases caused by traditional and non-traditional risk factors are the most common cause of morbidity and mortality in hemodialysis patients. Recently, much interest has been focused on non-traditional factors, such as oxidative stress, inflammation, and endothelial dysfunction. Hemodialysis patients are not only exposed to oxidative stress but also to inflammation. Although anticoagulants are the most frequently used drugs in hemodialysis patients, their effect upon oxidative stress and inflammation in dialysis patients are still unknown. Methods. Thirty-three hemodialysis patients were randomized into three groups. Group 1 received standard heparin while group 2 received low molecular weight heparin during the dialysis therapy. Group 3 (control group) did not receive any anticoagulant agent. Investigators were blinded to the therapy. Serum concentrations of oxidative stress and inflammation markers, including C-reactive protein, tumor necrosis factor alpha, superoxide dismutase, and malondialdehyde, were measured before and after dialysis session. Results. The oxidative stress and inflammation markers were significantly increased in groups 1 and 3 (p < 0.05 for each) compared to their baseline values. In contrast, baseline and end-treatment values of the oxidative stress and inflammation markers were comparable in the group 2 (p > 0.05). Conclusion. These findings indicate that the type of anticoagulants may take a role in the acute effect of hemodialysis upon oxidative stress and inflammation markers. A comparison of the groups revealed that low molecular weight heparin decreased the oxidative stress and inflammation, whereas standard heparin increased the oxidative stress and inflammation. Low molecular weight heparin appears to have an additive benefit for hemodialysis patients.     

Effects of Pomegranate Juice on Hyperoxaluria-Induced Oxidative Stress in the Rat Kidneys

To evaluate the role of the inducible nitric oxide synthase (iNOS), selective nuclear factor-kB (NF-kB), and p38-mitogene-activated protein kinase (p38-MAPK) on hyperoxaluria-induced oxidative stress and stone formation in rat kidneys. The rats were divided into five groups: group 1, control group; group 2: ethylene glycol (EG) group; group 3: EG?+?pomegranate juice (PJ)-low group; group 4: EG?+?PJ-middle group; group 5: EG?+?PJ-high group. Rats were sacrificed on 7, 15, and 45 days. The iNOS expression, p65-NF-kB and p38-MAPK activity, and oxidative stress markers were evaluated in the kidney. Crystal depositions were evident on day 7, and mild and severe crystallization were observed on day 15 and 45 in EG group, respectively. There was limited or no crystal formation in rats in both middle- and high-dose PJ groups when compared to low-dose PJ group. Crystal depositions, iNOS, p38-MAPK and p65-NF-kB activity, and oxidative stress markers were found to be decreased by middle- and high-dose PJ treatment. PJ was found to have inhibitory effects on renal tubular cell injury and oxidative stress caused by oxalate crystals by reducing ROS, iNOS, p38-MAPK, and NF-kB expression.