高剂量盐酸氨溴索对急性呼吸窘迫综合征合并呼吸机相关性肺炎的疗效观察  

Efficacy of high dose of ambroxol hydrochloride in treatment of acute respiratory distress syndrome complicated with ventilator-associated pneumonia

作　　者：丁凌[1] 杨莹[1] 

机构地区：[1]杭州市第三人民医院重症医学科,浙江杭州310009

出　　处：《中华医院感染学杂志》2013年第10期2322-2324,共3页Chinese Journal of Nosocomiology

基　　金：国家自然科学基金(81000757)

摘　　要：目的比较高剂量与低剂量盐酸氨溴索对急性呼吸窘迫综合征(ARDS)合并呼吸机相关性肺炎(VAP)的疗效,为临床诊断治疗提供决策依据。方法将62例并发VAP的ARDS应用盐酸氨溴索患者随机分为高剂量和低剂量两组,每组各31例,两组在相同的支持对症处理及抗感染基础上,低剂量组予以盐酸氨溴索30mg稀释于250ml生理盐水中,2次/d,静脉滴注;高剂量组则予300mg稀释于250ml生理盐水中,2次/d,静脉滴注。结果治疗1周后,高剂量组患者PaO2、PaO2/FiO2及CL分别为(95.7±11.8)mm Hg、(357±30.4)mm Hg、(88.4±19.2)ml/cm H2O均较治疗前升高,也显著高于低剂量组的(84.4±10.5)mm Hg、(249±26.7)mm Hg、(65.3±14.7)ml/cm H2O;高剂量组RAW、PIP分别为(33.1±6.0)cm H2O/(L.s)、(21.5±6.7)cm H2O较前降低,且与低剂量的(39.4±7.5)cm H2O/(L.s)、(28.6±7.0)cm H2O两组比较差异有统计学意义(P<0.05);虽然高剂量组较低剂量组机械通气时间更短,分别为(7.2±2.5)d、(12.7±3.3)d,细菌清除率更高,分别为88.33%、67.24%,死亡率分别为32.26%、41.94%,差异无统计学意义。结论高剂量盐酸氨溴索可显著改善并发VAP的ARDS患者肺通气功能、缩短机械通气时间;与抗菌药物联用产生协同作用,增强其细菌清除能力,但对总体死亡率无明显影响。OBJECTIVE To compare the efficacy of high dose of ambroxol hydrochloride in treatment of acute respiratory distress syndrome（ARDS） complicated with ventilator-associated pneumonia（VAP） so as to provide basis for the clinical diagnosis and treatment. METHODS A total of 62 ARDS patients complicated with VAP were divided randomly into the high-dose group and the low-dose group with 31 cases in each. All were treated with the same routine method and anti-infection therapy. On the basis of these, the low-dose group was treated with twice daily of 30rag ambroxol hydrochloride diluted in 250 ml normal saline by intravenous infusion, while 300rag was given each time in the high-dose group. RESULTS One week after the treatment, PaO2, PaO2/FiO2 and CL increased in both groups after treatment and the high-dose group （95.7±11.8 mmHg,357±30.4 mmHg,88.4±19.2 ml/cmH2O） seemed more apparently than the low-dose group （84.4 ± 10.5mmHg, 249 ＋ 26.7mmHg, 65.3 ± 14.7ml/emHz O）. RAW and PIP reduced more significantly in the high-dose group than did in the low-dose group after treatment. RAW were 33.1±6.0cmH2O/L . s, and 39.4±7.5cmHzO/L . s, and PIP were 21.5±6.7cmH2O and 28. 6 ± 7. 0cmH2O respectively, the difference was statistically significant （P 〈0. 05）. The duration of mechanical ventilation was shorter （7. 2 ± 2. 5d vs 12. 7 ± 3. 3d） and the bacterial clearance rate （88.33% vs 67.24%） was higher in the high-dose group than in the low-dose group, but the general mortality had no statistical difference（32.26% vs 41.94%）. CONCLUSION High dose of ambroxol hydrochloride can improve the pulmonary ventilation function and reduce the duration of mechanical ventilation of patients with ARDScomplicated with VAP. It has synergistic action of the combination with antibiotics, but it does not have obvious effect on reducing the general mortality.

关 键 词：呼吸机相关性肺炎 急性呼吸窘迫综合征 盐酸氨溴索 

分 类 号：R563.1[医药卫生—呼吸系统]