摘要
目的探究西维来司他钠联合地塞米松治疗创伤后急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的临床效果。方法随机选取2022年10月至2024年10月开封市人民医院80例ARDS患者进行研究。采用随机数字表法将患者均分为对照组(n=40)和观察组(n=40)。对照组接受地塞米松磷酸钠注射剂治疗,观察组行地塞米松磷酸钠注射剂联合西维来司他钠治疗。比较两组的Murray肺损伤评分(murray lung injury score,MLIS)、序贯器官功能衰竭(sequential organ failure assessment,SOFA)评分、血清炎性因子降钙素原(procalcitonin,PCT)、白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)水平、氧合指数(partial pressure of arterial oxygen/fraction of inspired oxygen,PaO 2/FiO 2)、乳酸(lactic acid,Lac)浓度和碳酸酐酶(carbonic anhydrase,CA)活性,以及不良事件、临床恢复和预后情况。结果两组经治疗后均有部分患者死亡,观察组与对照组病死率均为45.00%,组间比较差异无统计学意义(P>0.05);观察组机械通气时间为(8.10±2.06)d,明显短于对照组(P<0.05);观察组ICU住院时间为(11.83±2.42)d,与对照组相比差异无统计学意义(P>0.05)。治疗后,观察组MLIS为(5.10±2.16)分、SOFA为(7.23±2.86)分,明显低于对照组(P<0.05);观察组PCT为(0.35±0.04)ng/mL、IL-6为(121.39±16.37)pg/mL、CRP为(16.26±3.41)mg/L,较对照组更低(P<0.05);观察组PaO 2/FiO 2为(90.82±10.82)mmHg,较对照组更高,Lac为(3.59±0.53)mmol/L,低于对照组(P<0.05)。观察组不良反应总发生率为18.18%,略高于对照组,但差异无统计学意义(P>0.05)。结论西维来司他钠联合地塞米松治疗创伤后ARDS能够明显改善患者的肺损伤评分、降低血清炎性因子水平、提高氧合指数并减少乳酸水平,缩短机械通气时间,显示出较好的效果。然而,在ICU住院时间及病死率方面,受疾病本身等因素限制,尚未有明显改善,未来需进一步开展研究以优化治疗方案。
Objective To investigate the clinical efficacy of sivelestat sodium combined with aexamethasone in the treatment of post-traumatic acute respiratory distress syndrome(ARDS).Methods A total of 80 patients with ARDS at Kaifeng People's Hospital from October 2022 to October 2024 were randomly selected for the study.Using a random number table,the patients were equally assigned to a control group(n=40)and an observation group(n=40).The control group received dexamethasone sodium phosphate injection,while the observation group received a combination of dexamethasone sodium phosphate injection and sivelestat sodium.The following outcomes were compared between the two groups:Murray Lung Injury Score(MLIS),Sequential Organ Failure Assessment(SOFA)score,serum inflammatory markers including procalcitonin(PCT),interleukin-6(IL-6),and C-reactive protein(CRP)levels,oxygenation index(PaO 2/FiO 2),blood lactic acid(Lac)concentration,carbonic anhydrase(CA)activity,adverse events,as well as clinical recovery and prognosis.Results Some patients in both groups died after treatment.The mortality rate of the observation group was 45.00%,which showed no statistical significance compared with the control group(P>0.05).The mechanical ventilation time(8.10±2.06)days was significantly lower than that of the control group(P<0.05).However,the ICU hospitalization time(11.83±2.42)days and the mortality rate of 45.00%showed no statistical significance compared with the control group(P>0.05).After treatment,the MLIS(5.10±2.16)and SOFA(7.23±2.86)scores in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the observation group had lower levels of PCT(0.35±0.04)ng/mL,IL-6(121.39±16.37)pg/mL,and CRP(16.26±3.41)mg/L compared to the control group(P<0.05).The PaO 2/FiO 2(90.82±10.82)mmHg in the observation group was higher than that in the control group,while Lac(3.59±0.53)mmol/L was lower(P<0.05).The total incidence of adverse reactions in the observation group(10.00%)was slightly higher than that in the control group(5.00%),but the difference was not statistically significant(P>0.05).The mechanical ventilation time(8.10±2.06)days in the observation group was significantly shorter than that in the control group(P<0.05),while there was no statistically significant difference in ICU length of stay(11.83±2.42)days or mortality rate(45.00%)between the two groups(P>0.05).Conclusion The combination of sivelestat sodium and dexamethasone in the treatment of post-traumatic ARDS significantly improves lung injury scores,reduces serum inflammatory factor levels,increases the oxygenation index,decreases lactate levels,and shortens mechanical ventilation time,demonstrating favorable efficacy.However,limitations remain in terms of ICU length of stay and mortality reduction,necessitating further research to optimize the treatment regimen.
作者
田小红
李万华
TIAN Xiaohong;LI Wanhua(Department of Pharmacy,Kaifeng People's Hospital,Kaifeng 475000 China)
出处
《锦州医科大学学报》
2025年第5期44-49,共6页
Journal of Jinzhou Medical University
基金
开封市科技攻关项目,项目编号:2403085。
