大剂量盐酸氨溴索治疗老年呼吸机相关性肺炎患者的疗效观察

Curative effect of ambroxol in large dose on ventilator-associated pneumonia in the elderly

目的 探讨大剂量盐酸氨溴索对老年呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）患者的治疗作用. 方法 2009年1月至2011年1月应用盐酸氨溴索治疗的VAP患者76例,根据药物用量将其分为大剂量盐酸氨溴索组38例,应用盐酸氨溴索500 mg加生理盐水250 ml;常规剂量盐酸氨溴索组38例,应用盐酸氨溴索60 mg加生理盐水250 ml,两组均静脉滴注,2次/d,连续14d,所有患者其他治疗措施均依照2005年美国胸科协会呼吸机相关性肺炎指南.肺部感染程度采用降钙素原（procalcitonin,PCT）浓度和临床肺部感染评分（clinical pulmonary infection score,CPIS）描述,治疗效果以机械通气时间、气管切开率和二次插管率描述. 结果 大剂量盐酸氨溴索组PCT浓度和CPIS在治疗第5天及第14天分别为（0.79±0.68）mg/L、（0.44±0.36）mg/L、（5.50±2.08）分和（5.42±2.23）分,均明显低于常规剂量盐酸氨溴索组（1.18±0.97）mg/L、（1.11±0.91）mg/L、（6.61±2.32）分和（6.47±2.17）分（t=2.065、4.220、2.189、2.090,均P＜0.05）,大剂量盐酸氨溴索组PCT第14天明显低于同组第5天（P＜0.05）；大剂量盐酸氨溴索组机械通气时间、气管切开率及二次插管率分别为（6.03±1.87）d、7.9％和10.5％,均明显低于常规剂量盐酸氨溴索组（7.24±2.72）d、26.3％和31.6％（t=2.264,x2=4.547、5.066,均P＜0.05）. 结论 大剂量盐酸氨溴索治疗老年VAP患者有较好的临床疗效.

Objective To investigate the curative effect of large dose ambroxol on ventilatorassociated pneumonia（VAP）in the elderly.Methods From January 2009 to January 2011,76patients with VAP treated by ambroxol were randomly divided into general dose group and large dose group（n =38 for each group）.General dose group received 60 mg ambroxol in 250 ml normal saline,and large dose group received 500 mg ambroxol in 250 ml normal saline,intravenous drip,twice daily for 14 d.The other therapeutic measures in all patients were accorded to 2005 guidelines for the hospital-acquired pneumonia.Procalcitonin（PCT）and clinical pulmonary infection score（CPIS）were used to detect the degree of pulmonary infection.Treatment effects were described with duration of mechanical ventilation,rates of tracheotomy intubation and second endotracheal intubation.Results PCT concentrations and CPIS in large dose group during treatment of 5 d[（0.79±0.68）mg/L and （5.50±2.08）scores]and 14 d[（0.44 ± 0.36）mg/L and（5.42 ± 2.23）scores]were significantly lower than in general dose group at 5 d[（1.18±0.97）mg/L and（6.61±2.32）scores]and 14 d[（1.11±0.91）mg/L and（6.47±2.17）scores]（t =2.065,2.189,4.220 and 2.090,P〈0.05）,and the level of PCT in large dose group during treatment of 14 d was decreased as compared with 5 d（P〈0.05）.The time of mechanical ventilation,rates of tracheotomy intubation and second endotracheal intubation in large dose group[（6.03± 1.87）d,7.9% and 10.5%]were declined as compared with general dose group[（7.24±2.72）d,26.3% and 31.6%]（t=2.264,x2 =4.547,5.066,P〈0.05）.Conclusions Ambroxol in large dose for the treatment of VAP have better clinical efficacy than in general dose.