大剂量氨溴索对呼吸机相关肺炎患者的临床疗效观察

Curative effect of large dose of ambroxol on patients with ventilator-associated pneumonia

目的观察大剂量氨溴索应用对呼吸机相关肺炎(VAP)患者的临床疗效,评价其效果和安全性。方法选择2012年2-10月在北京大学第三医院急诊科ICU住院的71例VAP患者作为观察对象,常规剂量组37例,给予氨溴索治疗;大剂量组34例,给予氨溴索,疗程均为14d,对比两组患者各项指标的差异。结果大剂量组白细胞、中性粒细胞分类、CPIS评分、氧合指数治疗前较治疗后7d和14d相比差异有统计学意义(P<0.05);常规剂量、大剂量两组治疗前和治疗后7、14d白细胞、中性粒细胞和CPIS评分有降低趋势,白细胞、中性粒细胞和CPIS评分在治疗后7dP值分别为0.002、0.049和0.002,治疗后14dP值分别为0.020、0.038和0.001,差异有统计学意义(P<0.05);氧合指数呈升高趋势,在治疗14d后差异有统计学意义(P<0.05);常规剂量与大剂量组相比其住院天数分别为(42.68±19.85)d和(26.76±14.41)d、机械通气时间分别为(27.11±8.60)d和(19.18±10.30)d,有延长趋势,差异有统计学意义(P<0.05);48h内再次气管插管概率和病死率常规剂量组分别为10.81%、29.73%,大剂量组分别为8.82%、20.59%。结论大剂量氨溴索治疗VAP患者在缩短住院天数、机械通气时间有较好的临床疗效,再次气管插管概率和病死率较使用常规剂量氨溴索组降低。

OBJECTIVE To investigate the curative effect of large dose of ambroxol on the patients with ventilator- associated pneumonia（VAP）and evaluate the effect and safety. METHODS Totally 71 VAP patients who were hospitalized the ICU of the Peking University Third Hospital from Feb through Oct were enrolled in the study, the patients were randomly divided into the general dose group（n= 37） and the large dose group（n= 34）; then the general dose group was treated with ambroxol, the large dose group was treated with ambroxol, both of the treat- ment courses were 14 days, then the indicators were compared between the two groups. RESULTS The difference in the white blood cell, neutrophil classification, clinical pulmonary infection score（CPIS） or oxygenation index between 7 days and 14 days after the treatment was significant （P〈0.05）. The white blood cell, neutrophil classification and CPIS of the general dose group and the large dose group were decreased before the treatment or 7 days or 14 days after the treatment. The P value of the white blood cell, neutrophil classification and CPIS were respectively 0. 002, 0. 049, and 0. 002 7 days after the treatment and were respectively 0. 020, 0. 038, and 0. 001 14 days after the treatment, the difference was significant （P〈0.05）; the oxygenation index showed an upward trend, there was significance 14 days after the treatment （P〈0.05）; the hospitalization duration of the general dose group was （42.68±19.85）d, the large dose group（26.76±14.41）d; the mechanical ventilation time of the general dose group was （27.11±8.60）d, the large dose group （19.18±10.30）d, showing an upward trend, the difference was significant （P〈0.05）; the reintubation rate within 48 h was 10.81% in the general close group,8.82% in the large dose group; the mortality was 29.73% in the general dose group, 20.59% in the large dose group. CONCLUSION Large dose of ambroxol for the treatment of VAP can achieve significant clinical efficacy in shortening the duration of hospitalization as well as the duration of mechanical ventilation, with the reintubation rate and mortality lower than those of the general dose group.