机械通气辅以盐酸氨溴索对老年急性呼吸窘迫综合征患者动脉血气和细胞因子的影响

Effects of mechanial ventilation supplemented Ambroxol hydrochloride on arterial blood gas and cytokines in elderly patients with acute respiratory distress syndrome

目的探讨机械通气辅以盐酸氨溴索（沐舒坦）对老年急性呼吸窘迫综合征（ARDS）患者动脉血气和细胞因子的影响。方法对56例老年ARDS患者进入ICU后给予抗炎、吸痰、脱水和营养支持治疗，随机分为两组，治疗组在机械通气等常规治疗的基础上给予盐酸氨溴索20mg／kg＋生理盐水250mL缓慢（3h）静脉滴注；对照组在机械通气的基础上给予生理盐水250mL缓慢（3h）静脉滴注，两组连用7d观察各项指标。比较两组患者治疗前和治疗后7d氧合指标（Pa02／FiO2）及血清TNF-仪、IL-6及IL—10浓度的变化和差异。结果治疗后7d，治疗组动脉血氧分压（PaO：）、动脉血氧饱和度（SaO：）、PaO2／Fi02和血清IL-10浓度明显下降（P〈0．05），心率（HR）和血清TNF-α、IL-6浓度明显下降（P〈0．05），与对照组比较，差异均有统计学意义（P〈0．05）；治疗组动脉血二氧化碳分压（PaCO2）和平均动脉压（MAP）与对照组比较，差异无统计学意义（P〉0．05）。结论机械通气辅以盐酸氨溴索治疗可以改善老年ARDS患者的氧合，有效调节细胞因子的生成，提高疗效。

Objective To explore the effects of mechanial ventilation supplemented mucosolvan on arterial blood gas and cytokines in elderly patients with acute respiratory distress syndrome （ARDS）. Methods 56 elderly patients with ARDS were randomLy divided into two groups. Patiens in treatment group were treated with mechaoial ventilation and mucosolvan ＋ normal saline infusion, in control group with mechanial ventilation and normal saline infusion respectively for 7 days, while two groups were treated with anti -inflammation, furosemide, suction and nutritional support. The changes and differences of oxygenation indices and serum cytokines concentration were analyzed in two groups of before and after treatment. Results The arterial blood gas indices of PaO2 , SaO2 , PaO2/FiO2 and the serum cencentration of IL- 10 in treatment group improved significantly （P 〈 0.05 ）. HR and the serum cytokines concentration of TNF - c~, IL - 6 in treatment group decreased significantly （ P 〈 0.05 ）. Whereas the above indices were statiscally significant differences in two groups （P 〈 0.05）. PaCO2 and MAP were did not change significantly （ P 〉 0. 05 ）. Conclusion The treatment of mechanial ventilation supplemented mucosolvan can improve oxygenation and regulate cytokines of elderly patients with ARDS, thereby enhancing efficacy.