乙酰半胱氨酸雾化联合振动机械排痰治疗重型颅脑损伤后坠积性肺炎的临床研究  

Clinical study of acetylcysteine atomization combined with vibrating mechanical expectoration in the treatment of hypostatic pneumonia after severe craniocerebral injury

作　　者：郑涛 黄元志 吕文海 ZHENG Tao;HUANG Yuan-zhi;LV Wen-hai(Department of Neurosurgery,Xi'an International Medical Center Hospital,Xi'an 710000,Shaanxi,CHINA;Department of Neurosurgery,Xi'an Fengcheng Hospital,Xi'an 710000,Shaanxi,CHINA)

机构地区：[1]西安国际医学中心医院神经外科,陕西西安710000 [2]西安凤城医院神经外科,陕西西安710000

出　　处：《海南医学》2022年第8期1005-1008,共4页Hainan Medical Journal

摘　　要：目的观察乙酰半胱氨酸雾化吸入联合振动机械排痰治疗重型颅脑损伤后坠积性肺炎的临床疗效,并探讨其对患者外周血降钙素原(PCT)、白细胞计数(WBC)、肿瘤坏死因子-α(TNF-α)及血气指标的影响。方法选取2018年12月至2020年12月西安国际医学中心医院收治的105例重型颅脑损伤后坠积性肺炎患者,采用随机数字表分为研究组、对照1组和对照2组各35例。对照1组给予乙酰半胱氨酸雾化吸入治疗,对照2组给予振动机械排痰治疗,研究组给予乙酰半胱氨酸雾化吸入联合机械振动排痰治疗。于连续治疗10d后比较三组患者的临床疗效、机械通气时间、住院时间、死亡情况,以及治疗前后的PCT、WBC、TNF-α、动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、二氧化碳分压(PaCO_(2))水平。结果研究组患者的治疗总有效率为100.00%,明显高于对照2组的80.00%,差异有统计学意义(P<0.05),略高于对照1组的88.57%,但差异无统计学意义(P>0.05);研究组与对照1组、对照2组患者的机械通气时间[(11.92±2.25)d vs(16.82±3.05)d、(17.42±2.95)d]、住院时间[(15.22±3.10)d vs(20.58±3.11)d、(21.56±3.63)d]比较,研究组明显短于对照1组和对照2组,差异均有统计学意义(P<0.05),但三组患者30 d死亡率比较差异无统计学意义(P>0.05);治疗后,研究组与对照1组、对照2组患者的PCT[(0.15±0.06)mg/L vs(0.68±0.20)mg/L、(0.75±0.15)mg/L]、WBC[(5.86±1.02)×10^(9)/L vs(7.39±1.30)×10^(9)/L、(7.55±1.24)×10^(9)/L]、TNF-α[(19.33±2.52)ng/L vs(23.46±3.22)ng/L、(23.52±2.96)ng/L]、PaCO_(2)[(40.10±1.51)mmHg vs(42.69±1.36)mmHg、(42.72±1.62)mmHg]水平比较,研究组明显低于对照1组和对照2组,差异均有统计学意义(P<0.05);治疗后,研究组与对照1组、对照2组患者的PaO_(2)[(63.20±5.11)mmHg vs(57.22±4.23)mmHg、(57.19±4.52)mmHg]、SaO_(2)[(94.23±5.22)%vs(85.85±7.02)%、(85.02±6.96)%]水平比较,研究组明显高于对照1组和对照2组,差�Objective To observe the effect of atomized inhalation of acetylcysteine solution combined with vibrating mechanical expectoration on patients with hypostatic pneumonia after severe craniocerebral injury,and to investigate the effects of procalcitonin(PCT),white blood cell count(WBC),tumor necrosis factor-α(TNF-α),and blood gas indexes in peripheral blood of patients.Methods A total of 105 patients with hypostatic pneumonia after severe craniocerebral injury were selected from Xi'an International Medical Center Hospital from December 2018 to December 2020.They were divided into research group,control group 1,and control group 2,with 35 patients each by random number table.Patients in control group 1 were treated with acetylcysteine atomization,those in control group 2 were treated with simple vibrating mechanical expectoration,and patients in the research group were treated with acetylcysteine atomization combined with vibrating mechanical expectoration.The clinical efficacy,the duration of ventilatory support,length of hospital stay,death,and changes in procalcitonin(PCT),leukocyte(WBC),tumor necrosis factorα(TNF-α),arterial oxygen partial pressure(PaO_(2)),oxygen saturation(SaO_(2)),carbon dioxide partial pressure(PaCO_(2))levels before and after treatment were compared among the three groups after continuous treatment for 10 days.Results The total effective rate of the research group was 100.00%,which was significantly higher than 80.00%of the control group 2(P<0.05),but similar with 88.57%of the control group 1(P>0.05).The duration of ventilatory support and length of hospital stay in the research group were(11.92±2.25)d and(15.22±3.10)d,significantly shorter than(16.82±3.05)d and(20.58±3.11)d in the control group 1 and(17.42±2.95)d and(21.56±3.63)d in control group 2,and the differences were statistically significant(P<0.05).There was no significant difference in 30 d mortality among the three groups(P>0.05).After treatment,the levels of PCT,WBC,TNF-α,and PaCO_(2)in research group were(0.15±0.06)

关 键 词：乙酰半胱氨酸 振动机械排痰 重型颅脑损伤 坠积性肺炎 降钙素原 肿瘤坏死因子-α 

分 类 号：R651.15[医药卫生—外科学]