尼可地尔对急性呼吸窘迫综合征患者炎症因子的影响  

Effect of nicorandil on inflammatory factors in patients with acute respiratory distress syndrome

作　　者：刘兰[1] 叶八宁[1] 潘渝[1] 王宇辉[1] 胡远东[1] 李岑[1] 成小蓉[1] 施贤W清 

机构地区：[1]贵州省人民医院重症医学科,贵州贵阳550002

出　　处：《中国急救医学》2016年第4期341-344,共4页Chinese Journal of Critical Care Medicine

基　　金：贵州省科技厅--贵州省人民医院联合基金项目（黔科合LS字[2012]025号）

摘　　要：目的观察尼可地尔对急性呼吸窘迫综合征（ARDS）患者炎症因子的影响。方法采用前瞻性随机对照研究方法，选择2012—10～2014—10贵州省人民医院重症医学科ARDS患者40例，按完全随机化原则分为治疗组和对照组，每组20例。治疗组给予尼可地尔10mg胃管内注入，对照组给予温开水10mL胃管内注入，两组均每日3次，连用5d。余治疗两组相同。观察两组治疗前后氧合指数（PaO2／FiO2），血清超敏C反应蛋白（hs—CRP）、肿瘤坏死因子-α（TNF—α）、可溶性尿激酶型纤溶酶原激活物受体（suPAR）、高级糖基化终产物受体（RAGE）等血清炎症因子水平，急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及28d病死率。结果①两组患者性别、年龄、治疗前PaO2／FiO2、血清炎症因子水平及APACHEU评分比较差异无统计学意义。②治疗后治疗组血清炎症因子水平较对照组明显降低[hs—CRP（g／L）：13．50（5．93）VS．11．35（3．63），P=0．027；TNF—α（ng／L）：319．85（126．30）VS．256．90（120．73），P=0．016；suPAR（ng／mL）：18．40（4．27）VS．15．55（4．950），P=0．045；RAGE（pg／mL）：295．00（76．88）VS．276．80（72．40），P=0．011]，但PaO2／FiO2较对照组明显升高（141．37±45．82VS．224．72±85．12，t=-3．856，P=0．000）。③治疗后两组APACHE]]评分[（21．05±8．58）分VS．（18．70±11．21）分，t=0．743，P=0．462]及28d死亡率（25％vs．15％，x^2=0．1563，0．5〈P〈0，75）差异无统计学意义。结论尼可地尔可以减轻ARDS患者的炎症反应，改善氧合，但不能降低28d病死率。Objective To observe the effect of nicorandil on inflammatory factors in patients with acute respiratory distress syndrome （ARDS）. Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of People＇ s Hospital of Guizhou Province from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The treatment group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being 5 days in both groups. The rest of treatments were the same in the two groups. The oxygenation index（ PaOJFiO2 ）, inflammatory factors such as the blood high -sensitivi- ty C - reactive protein （ hs - CRP）, tumor necrosis factor - α （ TNF - α）, soluble urokinase type plasminogen activator receptor（ suPAR）, receptor for advanced glycation end products（RAGE） levels, acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score and 28 - day mortality were compared between two groups. Results （1）There were no significant difference in the basic state such as gender, age, PaO2/FiO2, inflammatory factors and APACHE Ⅱ score between two groups. （2）After treatment, the blood inflammatory factors levels of treatment group were significantly lower than those of control group [hs-CRP（g/L）： 13.50（5.93）vs. 11.35（3.63）, P=0.027; TNF-α（ng/L）： 319.85（126.30） vs. 256.90 （ 120.73 ）, P = 0. 016 ; suPAR （ng/mL） ： 18.40 （ 4.27 ） vs. 15.55 （ 4. 950 ）, P = 0. 045 ; RAGE （pg/mL） ：295.00 （76.88） vs. 276.80 （72.40）, P = 0.011 ] ; but the PaO2/FiO2 of treatment group was significantly higher than that of control group （ 141.37 ± 45.82 vs. 224.72 ± 85.12, t = -3. 856 ,P = 0. 000）. （3）There were no significant differences in APACHE Ⅱ score （21.05 ±8.58 vs. 18.70 ± 11.21, t = 0.743, P = 0.462） and 28 - day

关 键 词：尼可地尔 急性呼吸窘迫综合征(ARDS) 可溶性尿激酶型纤溶酶原激活物受体(suPAR) 高级糖基化终产物受体(RAGE) 28 d病死率 

分 类 号：R563.8[医药卫生—呼吸系统]