摘要
目的 观察盐酸氨溴索与血必净联合治疗对老年重症肺炎患者临床疗效的影响.方法 选择2015年1月至2016年12月苏州大学附属第三医院收治的60例老年重症肺炎患者,按随机数字表法将患者分为观察组和对照组,每组30例.两组均给予抗炎、营养支持、吸氧、解痉、化痰等常规治疗;对照组在常规治疗基础上将盐酸氨溴索300 mg加入到100 mL生理盐水中静脉滴注（静滴）,每日2次;观察组在对照组基础上将血必净50 mL加入到100 mL生理盐水中静滴,每日2次.均连用14 d后观察疗效.观察两组治疗前后免疫功能、炎症因子、呼吸力学和血气指标的变化以及临床疗效.结果 与治疗前比较,两组治疗后CD3＋、CD4＋、CD4＋/CD8＋、动脉血氧饱和度（SaO2）、动脉血氧分压（PaO2）、氧合指数（PaO2/FiO2）水平均显著升高,CD8＋、白细胞介素-6（IL-6）、C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）、气道平台压（Pplat）、吸气峰值压（PIP）、平均气道压（mPaw）、气道阻力（Raw）、动脉血二氧化碳分压（PaCO2）均显著降低（P〈0.05）,观察组治疗后CD3＋、CD4＋、CD4＋/CD8＋、SaO2、PaO2、PaO2/FiO2均显著高于对照组〔CD3＋：0.69±0.05比0.60±0.04,CD4＋：0.40±0.04比0.35±0.03,CD4＋/CD8＋：1.84±1.10比1.41±0.79,SaO2：0.96±0.04比0.91±0.05,PaO2（mmHg,1 mmHg=0.133 kPa）：97.71±10.03比74.68±8.14,PaO2/FiO2（mmHg）：361.87±20.01比258.95±17.54,均P＆lt;0.05〕,CD8＋、IL-6、CRP、TNF-α、Pplat、PIP、mPaw、Raw、PaCO2均显著低于对照组〔CD8＋：0.23±0.03比0.30±0.05,IL-6（pg/L）：97.48±8.14比144.51±12.67,CRP（mg/L）：31.26±4.85比68.97±7.02,TNF-α（mg/L）：16.07±1.80比21.85±2.64,Pplat（cmH2O,1 cmH2O=0.098 kPa）：12.23±1.57比15.97±1.91,PIP（cmH2O）：23.26±3.07比28.09±3.10,mPaw（cmH2O）：8.54±0.54比9.39±1.30,Raw（cmH2O·L^-1·s^-1）：6.74±1.12比9.29±1.55,PaCO2（mmHg）：36.44±4.13比47.07±5.35,均P〈0.05〕;治疗后观察组有效率显著高于对照组〔90.00%（27/30）比63.33%（19/30）,P〈0.05〕.结论 盐酸氨溴索与血必净联合治疗有助于提高老年重症肺炎患者的免疫功能,降低炎症反应,改善呼吸力学和血气指标,提高临床疗效.
Objective To investigate the therapeutic effect of ambroxol hydrochloride combined with Xuebijing injection for treatment of elderly patients with severe pneumonia. Methods A total of 60 patients with severe pneumonia admitted to the Third Affiliated Hospital of Soochow University from January 2015 to December 2016 were enrolled, and they were divided into an observation group and a control group by random number table method, 30 cases in each group. Both groups were given routine treatment of antibiotics, nutritional support, oxygen aspiration, spasmolysis and phlegm reduction therapies. etc. On the basic conventional treatment, the patients of the control group were treated with 300 mg ambroxol hydrochloride added into 100 mL normal saline for intravenous （IV） drip, twice a day; on the basis of treatment of control group, the patients in the observation group additionally were treated with 50 mL Xuebijing injection added into 100 mL normal saline for IV drip, twice a day. After treatment for 14 days, the curative effect was observed. Before and after treatment, the changes of immune function, inflammatory factors, respiratory mechanics, blood gas indexes and clinical efficacy were observed in the two groups. Results Compared with those before treatment, levels of the CD3＋, CD4＋ and CD4＋/CD8＋, arterial oxygen satuation （SaO2）, arterial partial pressure of oxygen （PaO2） and oxygenation index （PaO2/FiO2） in the two groups after treatment were significantly increased, while CD8＋, interleukin-6 （IL-6）, C-reactive protein （CRP）, tumor necrosis factor-α （TNF-α）, airway platform pressure （Pplat）, peak inspiratory pressure （PIP）, mean airway pressure （mPaw） and airway resistance （Raw） and arterial partial pressure of carbon dioxide （PaCO2） were decreased significantly after treatment in the two groups （all P〈0.05）, the levels of immune indexes CD3＋, CD4＋, CD4＋/CD8＋, SaO2, PaO2 and PaO2/FiO2 after treatment in the observation group were significantly higher than those in the control group [CD3＋： 0.69±0.05 vs. 0.60±0.04, CD4＋： 0.40±0.04 vs. 0.35±0.03, CD4＋/CD8＋： 1.84±1.10 vs. 1.41±0.79, SaO2： 0.96±0.04 vs. 0.91±0.05, PaO2 （mmHg, 1 mmHg =0.133 kPa）： 97.71±10.03 vs. 74.68±8.14, PaO2/FiO2 （mmHg）： 361.87±20.01 vs. 258.95±17.54, all P〈 0.05], meanwhile the CD8＋, IL-6, CRP, TNF-α, Pplat, PIP, mPaw, Raw and PaCO2 were significantly lower than those of the control group [CD8＋： 0.23±0.03 vs. 0.30±0.05, IL-6 （pg/L）： 97.48±8.14 vs. 144.51±12.67, CRP （mg/L）： 31.26±4.85 vs. 68.97±7.02, TNF-α （mg/L）： 16.07±1.80 vs. 21.85±2.64, Pplat （cmH2O, 1 cmH2O = 0.098 kPa）： 12.23±1.57 vs. 15.97±1.91, PIP （cmH2O）： 23.26±3.07 vs. 28.09±3.10, mPaw （cmH2O）： 8.54±0.54 vs. 9.39±1.30, Raw （cmH2O·L-1·s-1）： 6.74±1.12 vs. 9.29±1.55, PaCO2 （mmHg）： 36.44±4.13 vs. 47.07±5.35, all P 〈 0.05]. After treatment, the effective rate of the observation group was significantly higher than that of the control group [90.00% （27/30） vs. 63.33% （19/30）, P ＆lt; 0.05]. Conclusions Using ambroxol hydrochloride combined with Xuebijing injection for treatment of elderly patients with severe pneumonia can promote their immune function, reduce the inflammatory factors, improve respiratory mechanics and blood gas index levels, thus the combined therapy can elevate the clinical therapeutic effect for treatment of senile severe pneumonia.
作者
周曙俊
王瑰
叶吉如
Zhou Shujun Wang Gui Ye Jiru
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2017年第5期492-496,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
盐酸氨溴索
血必净
临床研究
肺炎
重症
Ambroxol hydrochloride
Xuebijing
Clinical study
Severe pneumonia
