Effects Of High Doses Ulinastatin On Multiple Organ Dysfunction After Cardiopulmonary Resuscitation

ObjectiveTo explore clinical curative effects and adverse reaction of high doses ofulinastatin (UTI) on patients of multiple organ dysfunction after cardiopulmonaryresuscitation, to provide a detailed basis for the clinical treatment of postresuscitation multiple organ dysfunction syndrome.Materials and Methods53patients admitted to our intensive care unit between January2011andDecember2013for advanced life support after cardiopulmonary resuscitation andreturn of spontaneous circulation after cardiac arrest in other departments, includingthe emergency department and other departments in our hospital, and other hospitals,were choosen for a prospective study. They were randomly divided into two groups.There were26patients in control group,18male patients and8female patients, andtheir average age was60.83±3.95years old, and average ROSC time was15.38±3.18mins. There were27patients in treatment group,27male patients and5femalepatients,their average age was59.78±3.44years old, and average ROSC time was14.31±2.92mins. Control group patients were intravenously given UTI200000Udissolved in20ml saline slowly,2times a day from the ICU admission day.Treatment group patients were intravenously pumped(100ml/h) UTI1million Udissolved in50ml saline on the ICU admission day, for5times, and the next day,they were given the same form of UTI treatment as the patients in control group.Therewere no differences in other treatments between the two groups. Data were recordedon the time admitted in ICU,24h,48h,72h,120h after admmition, including meanarterial pressure (MAP), APACHE Ⅱ score, arterial lactic acid (Lac), creatine kinaseisoenzyme (CK-MB), aspartate aminotransferase (AST), glutamic acid transaminase (ALT), total bilirubin (TBIL), urea nitrogen (BUN), creatinine (Cr) and urine output.ROSC time, duration of ICU stay, mortality rate, adverse reactions and complicationswere also recorded. SPSS17.0statistical software was used for data description andanalysis.ResultsCK-MB in two groups both reached the peak level in24h, and both declinedsignificantly in48h,72h and120h.CK-MB in the treatment group delined muchquicker than that in the control group. CK-MB in the treatment group in48h,72h,120h were significantly lower than that in24h (P<0.01).MAP in the treatment group in24h,48h,72h,120h rised gradually, andrespectively higher than that in control group (P<0.05or <0.01).AST, ALT and TBIL in24h in the two groups were both higher than those inICU admission time, and declined gradually in48h,72h,120h. ALT and TBIL in72h and120h in treatment group were respectively lower than those in control group(P<0.05or <0.01). ALT, TBIL in72h was obviously lower than those in24h intreatment group (P<0.05or <0.01). AST, ALT, TBIL in120h were significantlylower than those in24h (P<0.05or <0.01).BUN and Cr in24h in the two groups were both higher than those in ICUadmission time, and declined gradually in48h,72h,120h. BUN in72h and120h intreatment group were obviously lower than that in24h (P<0.01). Cr in120h wasobviously lower than that in24h in treatment group (P<0.01).Urine output of24h,48h,72h,120h increased in the two groups, and moreobvious in treatment group. Urine output of24h,48h,72h,120h in treatment groupwere more than those in control group (P<0.05or <0.01). In the treatment group,urine output of72h was more than that of24h (P<0.05).Lac in24h,48h,72h,120h in the two groups declined gradually. Lac of48h,72h,120h in the treatment group were lower than those in the control group and thanthat of24h in treatment group (P<0.05or <0.01).WBC count of24h were increased both in the two groups, and declined in48h,72h,120h in treatment group. WBC count of120h in treatment group was significantly lower than that in control group (P<0.05). In treatment group, WBC of72h and120h was obviously lower than that of24h (P<0.05or <0.01).APACHE Ⅱ scores in the two groups decreased after treatment. APACHEⅡscores of48h,72h,120h in the treatment group significantly lower than those inthe control group (P<0.05or <0.01). In the treatment group, APACHE Ⅱ scores of72h and120h were significantly lower than that of24h (P<0.05or <0.01).There was no difference between the control group and the treatment group inthe GCS scores of24h,48h,72h and120h (P>0.05), and there was no differenceamong the GCS scores of24h,48h,72h and120h in each group (P>0.05).The duration of ICU stay in the treatment group was less than that in the controlgroup (P<0.05).The mortality rate in the treatment group was lower than that in the control group(P<0.05).There was no complication or adverse reactions associated with UTI throughoutthe process.Conclusions1. High doses of UTI treatment has better protective effect on the PR-MODS.AST, ALT, BUN, Cr, TBIL, Lac are decreased significantly, urine output and MAPwere increased, and the tissue perfusion of organs are improved.2. High doses of UTI treatment could reduce the mortality rate of the patientsand the duration of ICU stay.3. There were no obvious adverse reactions in high doses of UTI treatment forPR-MODS.