Effects of ulinastatin combined with mechanical ventilation on oxygen metabolism, inflammation and stress response and antioxidant capacity of ARDS

Abstract

Acute respiratory distress syndrome (ARDS) is a disease that seriously threatens human life and health. The aim of the study was to investigate the effects of ulinastatin combined with mechanical ventilation on oxygen metabolism, inflammation and stress response, as well as the antioxidant capacity of ARDS. Eighty patients with ARDS treated in Yiwu Central Hospital from January, 2015 to December, 2016 were enrolled in the present study and divided into the observation (n=40) and control (n=40) groups, using a random number table. The control group was treated with mechanical ventilation, while the observation group, based on treatment of the control group, was treated with ulinastatin for 14 consecutive days as one course of treatment. The changes in the relevant indexes of oxygen metabolism, lung function, time of ventilator treatment, total hospital stay, and St. George's Respiratory Questionnaire (SGRQ) score of the two groups after intervention were compared, and the changes in inflammatory cytokine levels, dopamine receptor-related hormone levels, superoxide dismutase (SOD), malondialdehyde (MDA) and total antioxidant capacity of the two groups before intervention and at 1 and 4 weeks after intervention were compared. After intervention, the arterial blood lactate in the observation group was significantly lower than that in the control group (P<0.05), the oxygen uptake rate was significantly higher than that in the control group (P<0.05) and the arterial oxygen content was significantly higher than that in the control group (P<0.05). In the lung function indexes, the FEV₁ and FEV₁/FVC levels in the observation group were smaller than those in the control group (P<0.05), the duration of ventilator treatment was significantly shorter than that in the control group (P<0.05), and the hospital stay was significantly less than that in the control group (P<0.05). Prior to intervention, SGRQ scores in the two groups were not statistically significant (P>0.05). At 1 and 4 weeks after intervention, the SGRQ scores of the observation group were significantly increased to those of the control group (P<0.05). The tumor levels of necrosis factor-α (TNF-α), interleukin-6 (IL-6) and CRP were significantly lower than those of the control group (P<0.05). The levels of adrenaline and norepinephrine were significantly lower than those of the control group (P<0.05). The levels of MDA, SOD and the total antioxidant capacity were significantly increased to those of control group (P<0.05). The application of ulinastatin combined with mechanical ventilation in ARDS patients is of great significance in improving the oxygen delivery-consumption balance of body, increasing the lung function, reducing the inflammatory and stress response, and improving the antioxidant capacity.

Keywords: acute respiratory distress syndrome; antioxidant capacity; inflammatory response; mechanical ventilation; oxygen metabolism; stress response; ulinastatin.

Figure 1.

Comparison of changes in St. Georges Respiratory Questionnaire (SGRQ) scores during intervention. Prior to intervention, the SGRQ scores in the two groups were not statistically significant (^#P>0.05). At 1 and 4 weeks after intervention, the SGRQ scores of the observation group were significantly decreased compared to those of the control group (*P<0.05).

Figure 2.

Changes in inflammatory cytokine levels during intervention. There are no statistically significant differences in the levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and CRP between the two groups before intervention (^#P>0.05). At 1 and 4 weeks after intervention, the levels of TNF-α, IL-6 and CRP in observation group are significantly lower than those in control group (*P<0.05).

Figure 3.

Changes in dopamine receptor-related hormone levels of the two groups during intervention. There are no statistically significant differences in adrenaline and norepinephrine levels between the two groups before intervention (^#P>0.05). At 1 and 4 weeks after intervention, the levels of adrenaline and norepinephrine in the observation group were significantly lower than those in the control group (*P<0.05).

Figure 4.

Comparisons of superoxide dismutase (SOD), malondialdehyde (MDA) and total antioxidant capacity between the two groups during intervention. There were no statistically significant differences in MDA, SOD and total antioxidant capacity between the two groups before intervention (^#P>0.05). At 1 and 4 weeks after intervention, the levels of MDA, SOD was lower and total antioxidant capacity in the observation group were better to those in the control group (*P<0.05).