大剂量盐酸氨溴索治疗急性百草枯中毒肺损伤的临床研究  

Effects of high dose ambroxol hydrochloride in the treatment of pulmonary damage in acute paraquat poisoning

作　　者：王煜[1] 刘振宁[1] 赵敏[1] 

机构地区：[1]中国医科大学附属盛京医院急诊科,沈阳110004

出　　处：《实用药物与临床》2015年第7期784-787,共4页Practical Pharmacy and Clinical Remedies

基　　金：国家临床重点专科建设项目卫办医政函2012[649号]

摘　　要：目的观察大剂量盐酸氨溴索治疗急性百草枯(PQ)中毒肺损伤的临床效果。方法将40例急性百草枯中毒肺损伤患者分为治疗组(20例)和对照组(20例),对照组给予常规治疗,治疗组在对照组治疗基础上加用盐酸氨溴索注射液20 mg/(kg·d)静脉滴注q12h,连用5 d;观察两组动脉血气、HRCT变化,发生多脏器功能障碍综合征(MODS)病例,病死率与死亡病例存活时间。检测两组患者治疗前后血清丙二醛(MDA)、超氧化物歧化酶(SOD)及血清TNF-α、IL-6水平。结果治疗后两组动脉氧分压、氧合指数、HRCT改变等均有所改善(P<0.01或P<0.05),治疗组与对照组比较改善更为显著(P<0.05)。治疗组发生MODS病例数少于对照组(P<0.05),两组病死率比较差异无统计学意义(P>0.05)。两组患者治疗后血清MDA水平均下降,治疗组治疗后MDA水平下降较对照组更为明显(P<0.05);两组患者治疗后血清SOD水平均升高,治疗组治疗后SOD水平升高较对照组更为明显(P<0.05)。与治疗前比较,两组患者血清TNF-α和IL-6水平均显著降低(P<0.01);与对照组比较,治疗组患者TNF-α和IL-6降低更显著(P<0.05)。结论大剂量盐酸氨溴索注射液通过提高机体抗氧化能力,抑制脂质过氧化反应,抑制促炎因子的水平,减轻肺损伤,对急性PQ中毒肺损伤有一定治疗作用。Objective To observe the effect of high dose ambroxol hydrochloride in the treatment of pulmonary damage in acute paraquat poisoning. Methods Forty patients of acute paraquat poisoning w ith pulmonary damage w ere randomly divided into 2 groups： control group（ n = 20） and treatment group（ n = 20）. Control group received conventional therapy,and the treatment group w as added w ith intravenous infusion of ambroxol hydrochloride 20 mg /（ kg·d） q12 h for 5 d. The artery blood gas,HRCT film changes,the number of cases with multiple organ dysfunction syndrome（ MODS）,mortality,and survival time of the death cases w ere observed. Serum MDA,SOD and TNF-α,IL-6 levels w ere measured in 2 groups before treatment and at 5 d after treatment. Results After treatment,the oxygen partial pressure,oxygenation index,and HRCT film changes w ere all improved in the 2 groups（ P〈0. 01 or P〈0. 05）,there w as significant difference betw een the tw o groups（ P〈0. 05）. The number of MODS cases in treatment group w ere low er than those in control group（ P〈0. 05）,but no significant difference w as found in mortality betw een the tw o group（ P〈0. 05）. After treatment,plasma level of MDA all decreased in the 2 groups,there w as significant difference betw een the tw o groups（ P〈0. 05）; plasma level of SOD all rose in the 2 groups,there w as significant difference betw een the tw o groups（ P〈0. 05）. After treatment,plasma level of TNF-α,IL-6 all decreased in the 2groups,there w as significant difference betw een the tw o groups（ P〈0. 05）. Conclusion High dose ambroxol can be adopted to improve the ability of anti-oxidantion of the organism,inhibit lipid peroxidation and the levels of proinflammatory factor,lessen pulmonary damage,thus it has a certain therapeutic effect for treatment of acute paraquat poisoning.

关 键 词：盐酸氨溴索 急性百草枯中毒 急性肺损伤 氧自由基 炎症因子 

分 类 号：R595.4[医药卫生—内科学] R563[医药卫生—临床医学]