羟乙基淀粉130/0.4治疗外伤后致急性呼吸窘迫综合征的临床研究

Clinical study on hydroxyethyl starch 130/0.4 in treatment of acute respiratory distress syndrome induced by trauma

目的研究羟乙基淀粉130/0.4对外伤后致急性呼吸窘迫综合征的临床疗效。方法 50例外伤后致呼吸窘迫综合证的患者随机分为治疗组(25例)和对照组(25例),两组患者入院明确诊断后,分别行血常规、血生化、肝肾功能及血气检查,均给予机械通气,呼气末正压≥5 cm H2O(1 cm H2O=97.72 Pa)时,行APACHEⅡ评分,记录患者体征及氧合指数,且给予支气管肺泡灌洗,送支气管灌洗液(BALF)检查IL-6及白蛋白;对照组给予林格氏液1 000 mL,静脉滴注,1次/d;治疗组患者给予羟乙基淀粉130/0.4 1 000 mL,静脉滴注,1次/d,两组均治疗3 d。治疗结束后1 h复查血常规、血生化、肝肾功能及血气分析,记录氧合指数,再次行支气管肺泡灌洗,检测BALF中IL-6和白蛋白浓度。结果治疗后,治疗组症状改善优于对照组;对照组氧合指数及支气管肺泡灌洗液中白蛋白、IL-6前后变化无统计学差异,治疗组这3项指标治疗前后变化有明显统计学差异(P<0.05)。结论羟乙基淀粉130/0.4可减轻肺部炎症,有毛细血管堵漏作用,对急性呼吸窘迫综合征有保护作用。

Objective To study the clinical efficiency of hydroxyethyl starch on acute respiratory distress syndrome induced by trauma.Methods The patients（50 cases） diagnosed as acute respiratory distress syndrome were randomly divided into treatment（25 cases） and control（25 cases） groups.After diagnosis,the blood routine and biochemical,liver and kidney function,and blood gas examination of the two groups were investigated.All patients were given mechanical ventilation,and when positive end expiratory pressure ≥5 cm H2 O（1 cm H2 O=97.72 Pa） the APACHE II score,sign,and oxygen index were recorded.They were administered with bronchoalveolar lavage,and the bronchoalveolar lavage fluid（BALF） was sent to examine the IL-6 and albumin.Patients in the control group were iv administered with Ringers solution 1 000 mL,once daily.Patients in the treatment group were iv administered with hydroxyethyl starch 130/0.4 1 000 mL,once daily,and the two groups were treated for 3 d.One hour after the treatment,the blood routine and biochemical,liver and kidney function,blood gas examination and oxygen index in the two groups were reviewed.IL-6 and albumin of BALF were examined.Results After the treatment,the symptoms in the treatment group were better than that in the control group.There was no significant difference in oxygen index,IL-6,and albumin of BALF before and after the treatment,while there was significant difference in the three indexes of the treatment group before and after the treatment（P 0.05）.Conclusion Hydroxyethyl starch 130/0.4 could alleviate the degree of lung inflammation and has capillary plugging effect,which has the protective effect on acute respiratory distress syndrome.