甲泼尼龙联合吸入用乙酰半胱氨酸预防ICU气管插管患者拔管后喉喘鸣的应用价值  

Application value of methylprednisolone combined with inhaled acetylcysteine in preventing laryngeal stridor after extubation in ICU patients with endotracheal intubation

作　　者：熊泽忠 周宏伟[2] 韦有全[3] 庞晓军[4] 张梅[1] 沈世龙 韦荣升 蓬艳 何立术 韩志邦 XIONG Ze-Zhong;ZHOU Hong-Wei;WEI You-Quan(Intensive Care Department Zone 1,Qinzhou Second People′s Hospital,Qinzhou 535000,Guangxi,China;不详)

机构地区：[1]钦州市第二人民医院重症医学科一区,广西钦州535000 [2]钦州市第二人民医院呼吸与危重症医学科一区,广西钦州535000 [3]钦州市第二人民医院麻醉科,广西钦州535000 [4]钦州市第二人民医院临床药学科,广西钦州535000

出　　处：《吉林医学》2024年第3期653-658,共6页Jilin Medical Journal

基　　金：广西壮族自治区临床重点专科[项目编号:2021-17];钦州市科学研究与技术开发计划项目[项目编号:20199501]。

摘　　要：目的:探讨甲泼尼龙联合吸入用乙酰半胱氨酸预防ICU气管插管患者拔管后喉喘鸣的应用价值及咽痛发生影响因素。方法:选取2019年9月~2022年8月在钦州市第二人民医院已行气管插管时间≥24 h的患者300例作为研究对象,以数字表法将其分为对照组和观察组各150例。对照组给予吸入用乙酰半胱氨酸治疗,观察组基于对照组之上给予甲泼尼龙治疗,比较两组治疗后的临床效果和预后情况、临床症状指标、治疗前后血气指标、炎性因子、并发症发生率及重插管率。结果:观察组的临床治疗效果和预后率均优于对照组,差异有统计学意义(P<0.05)。观察组患者24 h喉喘鸣消退时间、声嘶消退时间、插管时间及拔管后住院时间均明显短于对照组,差异有统计学意义(P<0.05)。治疗后两组患者的各项血气指标较治疗前均有明显改善,且观察组氧合指数(PaO_(2)/FiO_(2))、动脉血氧分压(PaO_(2))高于对照组,血二氧化碳分压(PaCO_(2))低于对照组,差异均有统计学意义(P<0.05)。治疗后两组患者的炎性因子水平较治疗前显著降低,且观察组的白细胞介素-6(IL-6)、降钙素原(PCT)水平均明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者拔管后发生咽喉痛、喉头水肿、呼吸困难等拔管后并发症总发生率及再插管率均明显低于对照组,差异均有统计学意义(P<0.05)。结论:与单一的吸入用乙酰半胱氨酸预防相比较,将甲泼尼龙与吸入用乙酰半胱氨酸联合应用于ICU气管插管患者中效果更佳,能有效改善血气指标与预后情况,缓解临床症状,降低炎性反应水平和再插管率,拔管后并发症少,安全性良好。Objective To explore the application value of methylprednisolone combined with inhalation of acetylcysteine in preventing laryngeal stridor after extubation in ICU patients with endotracheal intubation and the influencing factors of pharyngodynia.Method 300 patients hospitalized in the ICU of Qinzhou Second People′s Hospital from September 2019 to August 2022 who had undergone endotracheal intubation for≥24 hours were selected as the research object,they were divided into the control group and the observation group by the numerical table method,150 patients in each group.The control group was treated with acetylcysteine inhalation,and the observation group was treated with methylprednisolone based on the control group.The clinical effects,prognosis,clinical symptom indicators Blood gas index,inflammatory factors,complication rate and re intubation rate before and after treatment were compared.Results The clinical efficacy and prognosis of the observation group were better than those of the control group(P<0.05);The 24-hour time of laryngeal asthma resolution,hoarseness resolution,intubation time and hospitalization time after extubation in the observation group were significantly shorter than those in the control group(P<0.05).After treatment,all the blood gas indexes of the patients in the two groups were improved compared with those before treatment,the oxygenation index(PaO_(2)/FiO_(2))and the arterial partial pressure of oxygen(PaO_(2))in the observation group was higher than that in the control group,while blood partial pressure of dioxide(PaCO_(2))were lower than those in the control group(P<0.05).After treatment,the levels of inflammatory factors in the two groups were significantly lower than those before treatment,the levels of interleukin-6(IL-6)、Procalcitonin(PCT)were significantly lower than those in the control group(P<0.05);The total incidence of post extubation complications such as sore throat,laryngeal edema and dyspnea in the observation group treated with methylprednisolone combined with

关 键 词：甲泼尼龙 乙酰半胱氨酸 预防 重症监护室 气管插管 喉喘鸣 

分 类 号：R974[医药卫生—药品]