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目的 观察不同剂量乌司他丁注射剂对老年重型颅脑损伤患者氧化应激、免疫功能及颅内压的影响.方法 将117例老年重型颅脑损伤患者随机分为A组(42例)、B组(38例)和C组(37例).在常规治疗的基础上,A组每12 h给予乌司他丁10万U;B组每12 h给予20万U;C组每12h给予40万U.治疗后10 d,观察3组氧化应激指标、免疫功能指标、颅内压差异及药物不良反应发生情况.结果 治疗后,A,B,C组丙二醛(MDA)分别为(12.14±3.56),(8.65±3.41)和(5.03±1.94)nmrol· L-1;髓过氧化物酶(MPO)分别为(6.35±1.45),(5.27±1.23)和(3.84±1.34) mg·L-1;脂质过氧化物(LPO)分别为(6.79±2.84),(5.35±2.13)和(4.21±1.39)mg·L-1.MPO、MDA、LPO水平在3组间两两比较差异均有统计学意义(均P ＜0.05).治疗后,A,B,C组CD3+分别为(54.34±8.24)％,(58.32±9.23)％,(63.06±9.76)％;CD4+分别为(30.95±3.12)％,(34.53±3.87)％和(33.97±4.26)％;CD8+分别为(24.45±4.05)％,(27.56±3.34)％和(28.37±4.53)％;CD4 +/CD8+值分别为1.07±0.26,1.21±0.30和1.36±0.36.CD3+、CD4+、CD4 +/CD8+水平在3组间两两比较差异均有统计学意义(均P ＜0.05);CD8+水平在B、C组差异无统计学意义(P＞0.05),A组与B、C组比较,差异均有统计学意义(均P ＜0.05).治疗后3,7,11 d,A组颅内压分别为(23.42±3.15),(17.17±3.28)和(15.38±4.16) mmHg;B组分别为(21.25±2.83),(15.04±3.27)和(12.65±3.87) mmHg;C组分别为(18.16±3.12),(13.98±0.24)和(11.32±1.24) mmHg.3组颅内压水平比较,差异均有统计学意义(均P＜0.05).3组治疗期间的药物不良反应有白细胞下降、皮疹、皮肤瘙痒、血管疼痛和丙氨酸氨基转移酶升高,3组药物不良反应发生率差异均无统计学意义(均P＞0.05).结论 不同剂量乌司他丁对老年重型颅脑损伤患者氧化应激、免疫功能及颅内压的影响显著不同,大剂量应用存在优势.“,”Objective To observe the effect of different doses of ulinastatin on oxidative stress,immune function and intracranial pressure in elderly patients with severe traumatic brain injury.Methods A total of 117 cases of elderly patients with severe traumatic brain injury were randomly divided into group A (42 cases),group B (38 cases) and group C (37 cases).On the basis of conventional treatment,group A was given ulinastation 1 × 105 U every 12 h.Group B was given ulinastation 2 × 105 U every 12 h.Group C was given ulinastation 4 × 105 U every 12 h.All patients were treatment for 10 d.The levels of oxidative stress indexes,immune function indexes and intracranial pressure and adverse drug reactions among the three groups were observed.Results After treatment,the levels of malondialdehyde (MDA) in A,B,C groups were (12.14 ± 3.56),(8.65 ± 3.41),(5.03 ± 1.94)nmol · L-1.Myeloperoxidase (MPO) levels were (6.35 ± 1.45),(5.27 ± 1.23) and (3.84 ± 1.34) mg · L-1,respectively.Lipid peroxide (LPO) levels were (6.79 ± 2.84),(5.35 ± 2.13) and (4.21 ± 1.39) mg · L-1.The differences of MPO,MDA,LPO levels in each group were statistically significant compared with those in other groups (all P ＜ 0.05).After treatment,CD3 + levels in A,B,C groups were (54.34 ± 8.24) ％,(58.32 ± 9.23) ％ and (63.06 ± 9.76) ％.CD4 + levels were (30.95±3.12)％,(34.53 ± 3.87)％ and (33.97 ± 4.26)％.CD8+ levels were (24.45 ± 4.05)％,(27.56 ±3.34) ％ and(28.37 ±4.53)％.CD4 +/CD8+ were 1.07 ±0.26,1.21 ±0.30 and 1.36 ±0.36,respectively.The differences of CD3 +,CD4 + and CD4 +/CD8 + levels in each group compared with those in other groups were statistically significant (all P ＜ 0.05).The levels of CD8 + had no significant difference between group B and group C (P ＞ 0.05),but there was statistically significant in group A compared with group B and C (P ＜ 0.05).Intracranial pressure on 3,7 and 11 d after treatment of group A were (23.42 ± 3.15),(17.17 ± 3.28),(15.38 ± 4.16) mmHg;group B were (21.25 ±2.83),(15.04 ±3.27),(12.65 ±3.87) mmHg;group C were (18.16 ±3.12),(13.98 ±0.24) and (11.32 ± 1.24) mmHg.The differences of intracranial pressure in three groups were statistically significant (all P ＜ 0.05).The adverse drug reactions in 3 groups during the treatment were leukocyte decrease,rash,pruritus,vascular and elevated alanine aminotransferase,there were no significant differences in adverse drug reactions among 3 groups (all P ＞ 0.05).Conclusion Different doses of ulinastatin have different effects on oxidative stress,immune function and intracranial pressure in elderly patients with severe craniocerebral brain injury,and the application of high dosage has advantages.