西维来司他钠联合APRV治疗小儿重度ARDS的前瞻性随机对照研究  

A prospective Randomized Controlled Study of Cilvelestat Sodium Combined with Airway Pressure Release Ventilation in the Treatment of Severe Acute Respiratory Distress Syndrome in Children

作　　者：王维娟 李娜 王璐 成钧 WANG Weijuan;LI Na;WANG Lu;CHENG Jun(Pediatric Intensive Care Unit,Northwest Women and Children’s Hospital,Xi’an 710061,China)

机构地区：[1]西北妇女儿童医院儿童重症监护室,西安710061

出　　处：《中国医院用药评价与分析》2024年第11期1329-1332,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：陕西省重点研发计划项目(No.2021SF-026)。

摘　　要：目的:探讨西维来司他钠联合气道压力释放通气(APRV)治疗小儿重度急性呼吸窘迫综合征(ARDS)的临床效果。方法:前瞻性选取2021年5月至2023年5月该院收治的重度ARDS患儿102例,按照随机数字表法分为对照组和研究组,各51例。对照组患儿给予APRV+基础对症治疗,研究组患儿给予西维来司他钠+APRV+基础对症治疗。比较两组患儿的临床症状体征、临床疗效和并发症发生率,治疗前后的肺功能指标、动脉血气指标和炎症因子水平。结果:研究组患儿的总有效率为94.12%(48/51),明显高于对照组的80.39%(41/51),差异有统计学意义(P<0.05)。研究组患儿机械通气时间、气促消失时间、肺部啰音消失时间和住院时间较对照组缩短,差异均有统计学意义(P<0.05)。治疗3、7 d后,两组患儿的血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))高于治疗前,血二氧化碳分压(PaCO_(2))低于治疗前;且研究组患儿PaO_(2)、SaO_(2)和PaCO_(2)的变化幅度大于对照组,差异均有统计学意义(P<0.05)。治疗3、7 d后,两组患儿的最大呼气压、最大呼气流量、最大吸气压和最大呼气中段流量较治疗前升高,且研究组患儿高于对照组;治疗3、7 d后,两组患儿血清C反应蛋白、肿瘤坏死因子α、巨噬细胞移动抑制因子-1和白细胞介素6水平较治疗前降低,且研究组患儿低于对照组,差异均有统计学意义(P<0.05)。研究组患儿的并发症发生率为5.88%(3/51),低于对照组的21.57%(11/51),差异有统计学意义(P<0.05)。结论:西维来司他钠联合APRV治疗小儿重度ARDS的疗效显著,能有效抑制患儿血清炎症因子释放,改善患儿血气分析指标、临床症状和肺功能,且能减少并发症的发生。OBJECTIVE:To probe into the clinical effects of cilvelestat sodium combined with airway pressure release ventilation(APRV)in the treatment of severe acute respiratory distress syndrome(ARDS)in children.METHODS:A total of 102 children with severe ARDS admitted into the hospital from May 2021 to May 2023 were prospectively selected and divided into the control group and study group according to the random number table method,with 51 cases in each group.The control group was given APRV+basic symptomatic treatment,while the study group received cilvelestat sodium+APRV+basic symptomatic treatment.The clinical signs and symptoms,clinical efficacy and complications,the lung function indicators,arterial blood gas indicators,and inflammatory factor levels before and after treatment were compared between two groups.RESULTS:The total effective rate of the study group was 94.12%(48/51),significantly higher than that 80.39%(41/51)of the control group,the difference was statistically significant(P<0.05).The mechanical ventilation time,disappearance time of shortness of breath,disappearance time of lung rales and length of stay in the study group were shorter than those in the control group,the differences were statistically significant(P<0.05).After 3 and 7 d of treatment,the partial pressure of oxygen(PaO_(2))and arterial oxygen saturation(SaO_(2))in both groups were higher than those before treatment,and the partial pressure of carbon dioxide(PaCO_(2))was lower than that in the control group,and the change range of PaO_(2),SaO_(2) and PaCO_(2) in the study group was greater than that in the control group,with statistically significant differences(P<0.05).After 3 and 7 d of treatment,the maximum expiratory pressure,peak expiratory flow rate,maximum inspiratory pressure,and maximum expiratory mid-flow rate in both groups increased compared with those before treatment,and the study group was higher than the control group;after 3 and 7 d of treatment,the levels of serum C-reactive protein,tumor necrosis factorα,macrophage migra

关 键 词：西维来司他钠 气道压力释放通气 急性呼吸窘迫综合征 动脉血气 肺功能 

分 类 号：R974[医药卫生—药品]