摘要
目的分析西维来司他钠(silverestana)联合甲泼尼龙琥珀酸钠(methylprednisolone sodium succinate)、气道压力释放通气(airway pressure release ventilation,APRV)治疗脓毒症所致急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺功能的影响。方法选取2020年1月至2024年12月我院收治的脓毒症所致ARDS患者54例为对象,按照治疗方法分为对照组31例,使用APRV治疗,同时给予甲泼尼龙琥珀酸钠每日40 mg,静脉滴注;观察组23例,在对照组治疗方案的基础上,给予西维来司他钠每日4.8 mg/kg,静脉泵入。连续给药7 d。比较两组患者血液学指标、肺功能、肺部CT影像学结果、急性生理学及慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHE-Ⅱ)评分、默里肺损伤评分(Murray lung injury score,MLIS)、脓毒症相关序贯器官衰竭(sequential organ failure assessment,SOFA)评分、不良反应和预后。结果两组ARDS患者治疗后血氧分压(PaO_(2))、氧合指数(PaO_(2)/FiO_(2))水平较治疗前升高(P<0.05),两组比较无统计学差异(P>0.05);动脉血二氧化碳分压(PaCO_(2))、中性粒细胞百分比(neutrophil granulocyte,NEUT)、白细胞介素-6(interleukin-6,IL-6)、肺水指数(extravascular lung water index,ELWI)、降钙素原(procalcitonin,PCT)、门冬氨酸氨基转氨酶(aspartate aminotransferase,AST)、血肌酐、C-反应蛋白(C-reactive protein,CRP)水平较治疗前降低(P<0.05),PaCO_(2)、NEUT、内皮细胞特异性分子(endothelial cell specific molecule-1,ESM-1)、AST、肌酐比较水平无统计学差异(P>0.05);观察组IL-6(0.47±0.06)ng/L、PCT(0.43±0.07)ng/ml、CRP(12.38±3.17)mg/L低于对照组(0.52±0.09)ng/L、(0.48±0.09)ng/ml、(14.35±3.62)mg/L(P<0.05)。肺功能Cdyn水平升高,PEEP、ELWI水平降低(P<0.05);Cdyn水平(18.28±3.45)ml/cm高于对照组(16.47±3.06)ml/cm(P<0.05);ELWI水平(8.34±1.39)ml/kg低于对照组(9.23±1.75)ml/kg(P<0.05),PEEP水平无统计学差异(P>0.05)。观察组APACHE-Ⅱ评分(13.19±2.12)分、MLIS评分(2.26±0.34)分、SOFA评分(6.32±1.17)分低于对照组(14.65±2.68)分、(2.54±0.35)分、(7.14±1.48)分(P<0.05)。观察组经救治生存者18例(78.26%),救治无效死亡者5例(21.74%);对照组生存者16例(51.61%),治疗无效死亡者15例(48.39%),观察组生存率高于对照组(P<0.05)。结论西维来司他钠与甲泼尼龙琥珀酸钠结合APRV救治,可改善ARDS患者血气指标和肺功能,降低炎症水平,改善预后具有临床意义。
Objective To analyze the impact of silverestana combined with methylprednisolone sodium succinate and airway pressure release ventilation(APRV)on lung function in patients with acute respiratory distress syndrome(ARDS)caused by sepsis.Methods A total of 54 patients with ARDS due to sepsis admitted to our hospital from January 2020 to December 2024 were selected.They were divided into a control group of 31 patients and an observation group of 23 patients based on the treatment method.Both groups received conventional treatment and respiratory management.The control group was treated with APRV and intravenous infusion of 40 mg of methylprednisolone sodium succinate daily.The observation group received an additional 4.8 mg/kg of silverestana intravenously via a pump on top of the control group′s treatment regimen.The medications were administered continuously for 7 days.Hematological indicators,lung function,lung CT imaging results,acute physiology and chronic health evaluation Ⅱ(APACHE-Ⅱ)scores,murray lung injury scores(MLIS),sequential organ failure assessment(SOFA)scores,prognosis,and adverse reactions were compared between the two groups.Results After treatment,the observation group exhibited lower levels of interleukin-6(IL-6)(0.47±0.06)ng/L,procalcitonin(PCT)(0.43±0.07)ng/ml,C-reactive protein(CRP)(12.38±3.17)mg/L,and extravascular lung water index(ELWI)(8.34±1.39)ml/kg,APACHE-Ⅱ(13.19±2.12)points,MLIS(2.26±0.34)points,and SOFA(6.32±1.17)points compared to the control group,which had values of(0.52±0.09)ng/L,(0.48±0.09)ng/ml,(14.35±3.62)mg/L,(9.23±1.75)ml/kg,(14.65±2.68)points,(2.54±0.35)points,and(7.14±1.48)points,respectively.The observation group showed higher dynamic lung compliance(Cdyn)values(18.28±3.45)ml/cm and a higher survival rate of 18 cases compared to the control group,which had values of(16.47±3.06)ml/cm and 16 cases,respectively(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The combination of silverestana with methylprednisolone sodium succinate and APRV has clinical significance in improving blood gas indicators and lung function,reducing inflammation levels,and improving the prognosis of ARDS patients.
作者
李兴华
李桂仙
刘颖
耿红玉
顾莹
韩聪聪
Li Xinghua;Li Guixian;Liu Ying;Geng Hongyu;Gu Ying;Han Congcong(Department of Critical Care MedicineⅡ,Army 82nd Army Military Hospital,Hebei Baoding 071000,China;General Medical Medical,Army 82nd Army Military Hospital,Hebei Baoding 071000,China;Nursing department,Baoding First Central Hospital,Baoding 071000,China;Department of Critical Care Medicine,Baoding First Central Hospital,Baoding 071000,China)
出处
《中华肺部疾病杂志(电子版)》
2025年第5期789-795,共7页
Chinese Journal of Lung Diseases(Electronic Edition)
基金
保定市科技计划项目(2141ZF265)。
关键词
急性呼吸窘迫综合征
西维来司他钠
甲泼尼龙琥珀酸钠
气道压力释放通气
脓毒症
Acute respiratory distress syndrome
Silverestana
Methylprednisolone sodium succinate
Airway pressure release ventilation
Sepsis
