氨茶碱在产科重症中的临床应用价值分析  

Clinical application value of aminophylline in critical illness of obstetrics

作　　者：王英[1] 王雨平[1] 任婵[1] 祝艳翠[1] 单可记[1] Wang Ying;Wang Yuping;Ren Chan;Zhu Yancui;Shan Keji(Department qf Critical Care Medicine,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科,云南昆明650032

出　　处：《中国中西医结合急救杂志》2021年第1期74-77,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：云南省教育厅科研基金项目(2020J0155)。

摘　　要：目的分析氨茶碱在急危重症孕产妇中的应用价值.方法选择2015年7月至2019年9月昆明医科大学第一附属医院重症医学科收治的80例急危重症孕产妇作为研究对象,按治疗方法不同分为西医常规治疗组和氨茶碱组,每组40例.西医常规治疗组给予呼吸、循环支持,监测心电图(ECG)、脉搏血氧饱和度(SpO_(2))及血压(有创),纠正贫血、低蛋白血症,抗感染、利尿、维持水和电解质平衡、保护重要器官功能等治疗;氨茶碱组在常规治疗基础上给予氨茶碱,首次负荷量0.125~0.250 g,之后将氨茶碱0.5 g加入生理盐水至50 mL,以2 mL/h(3~6μg·kg^(-1)·min^(-1))持续静脉泵注,输注2 d以上,每隔3 d监测1次氨茶碱血药浓度.两组均常规行桡动脉穿刺置管,连续监测有创动脉血压,于治疗前和治疗1、2、3 d各时间点行动脉血气分析,记录两组患者氧合指数、24 h输液总量、尿量、体重、血压、心率、机械通气时间及重症监护病房(ICU)住院时间.结果两组随时间延长氧合指数逐渐升高,尿量逐渐增加,体重和心率逐渐下降,氧合指数于治疗2 d时氨茶碱组和与西医常规治疗组出现统计学差异〔氧合指数(mmHg,1 mmHg≈0.133 kPa):250.00(227.46,258.04)比195.00(192.78,220.22),P<0.05〕,尿量、体重、心率均于治疗1 d时即出现统计学差异〔尿量(mL/d):4000.00(3650.00,4500.00)比3000.00(2800.00,3300.00),体重(kg):70.00(68.00,74.00)比73.00(70.00,75.75),心率(次/min):95.00(80.00,100.00)比100.00(91.25,110.00),均P<0.05〕,持续到治疗3 d时,且氨茶碱组的变化较西医常规治疗组更显著〔氧合指数(mmHg):292.50(277.54,309.71)比200.00(203.88,228.97),尿量(mL/d):5400.00(5062.22,5842.78)比3500.00(3251.31,3628.69),体重(kg):63.50(60.25,65.75)比69.00(67.25,72.00),均P<0.05〕.治疗2 d时氨茶碱组舒张压明显高于西医常规治疗组〔mmHg:75.00(73.60,78.90)比70.00(67.45,72.75),P<0.05〕,治疗3 d时明显低于西医常规治疗组〔mmHg:70.00(67.74,Objective To analyze the application walue of aminophylline in the treatment of critical patients with severe maternal disease.Methods Eighty obstetrically critical patients admitted to the intensive care unit(ICU)of the First Affiliated Hospital of Kunming Medical University from July 2015 to September 2019 were selected as research objects,and divided into Western medicine routine treatment group and aminophylline group,with 40 cases in each group.The Western medicine routine treatment group was routinely treated according to the patients'conditions.The patients were given respiratory and circulatory support,closely monitoring electrocardiogram(EGG),pulse oxygen saturation(SpO2)and blood pressure(invasive),correcting anemia and hypo-proteinemia,anti infection,diuresis,maintaining the balance of water and electrolyte,and protecting the function of important organs;aminophylline group was given aminophylline on the basis of routine treatment.The first dose was 0.125-0.250 g,then addition of aminophylline 0.5 g into normal saline 50 mL continuously intravenously infused by pump was conducted at the speed of 2 mL/h(μg·kg^(-1)·min^(-1))for more than 2 days.The serum concentration of aminophylline was monitored every 3 days.The two groups underwent routine radial artery catheterization and continuous invasive arterial blood pressure monitoring.Arterial blood gas analysis was performed before treatment and at each time point of 1,2 and 3 days of treatment.The oxygenation index,24 hours total infusion volume,urine volume,body mass,blood pressure,heart rate,mechanical ventilation time and ICU stay time were recorded.Results With the prolongation of time,in the two groups gradually the oxygenation index and urine volume were increased,and the body weight and heart rate were decreased.There was significant difference in oxygenation index between the aminophylline group and Western medicine conventional treatment group on day 2 of treatment[oxygenation index(mmHg,1 mmHg≈0.133 kPa):250.00(227.46,258.04)vs.195.00(192.78

关 键 词：产科急危重症 氨茶碱 临床疗效 

分 类 号：R47[医药卫生—护理学]