多西环素对重度吸入性损伤患者的肺功能改善作用

Therapeutic effect of doxycycline in patients on lung fuction following severe inhalation injury

目的观察多西环素对吸人性损伤患者的肺功能改善作用并探讨其机制。方法将22例重度吸人性损伤患者随机分为治疗组（n=12）和对照组（n=10）。两组均采取入住烧伤重症监护室，液体复苏，早期气管切开并应用呼吸机辅助呼吸，应用广谱抗生素防治感染，于气管切开前、切开后每1～2d应用纤维支气管镜行局部灌洗等方法治疗，于住院后0、24、72、120h测两组患者静脉血清中基质金属蛋白酶-2（MMP-2）、白介素-1β（IL-1β）含量；每12h测动脉血气分析，计算两组的氧合指数（OI）=血氧分压（PaO：）／吸氧浓度（FiO2），记录乳酸值（LAC）。另治疗组常规经胃管注入多西环素片[第1天每12h1次2mg／（kg·d），以后24h1次2mg／（kg·d），共服用3d]，对照组经胃管注入安慰剂。比较两组的急性呼吸窘迫综合征（ARDS）发生率和死亡率，以及OI、LAC、MMP-2、IL-1β值。对计量资料采用t检验，计数资料用）（。检验。结果两组患者7d内ARDS发生率、死亡率差异无统计学意义（P〉0．05），伤后72h起治疗组较对照组OI值高（P〈0．05），LAC值低（P〈0．05），MMP-2、IL-1β低（P〈0．05）。结论多西环素可改善吸人性损伤患者的呼吸功能，机制可能为发挥基质金属蛋白酶抑制剂和拮抗细胞因子作用。

Objective To observe the effect of doxycycline tablets on acute respiratory distress syndrome following inhalation injury. Methods 22 burned patients with severe inhalation injury hospitalized from October 2007 to October 2012, were divided into two groups, 12 patients randomly entering treatment group and 10 patients entering control group. Patients in C group were treated with routine methods, including transferred to Burn Intensive Care Unit, fluid resuscitation based on the Third Military Medical University formula, anti infection treatment, early tracheostomy,mechanical ventilation,lung lavage by flexible fiberoptic bronchoscope, support treatment, and organ-protection treatment,etc. In addition to routine treatment methods,patients in T group received doxycycline tablets once a day [ the intake was 4 mg/（ kg · d） on the first day, on the second and third day the intake was 2 mg/（ kg @ d）]. Venous blood of patients was drawn at post burn hour 0,24,72,and 120 to determine the serum levels of MMP-2, IL-1β. OI,LAC, and PEEP values were recorded twice a day. Data were processed with t test or Chisquare test. Results There was no difference in incidence of ARDS and mortality between the two groups （P 〉 0.05）. The levels of LAC, PEEP, MMP-2 and IL-1β were lower in T group than in C group after 72 hours. The level of OI was higher. Differences in contents of these parameters between two groups were statistically significant （ P 〈 0.05 ）. Conclusion Early use of doxycycline tablets in patients following inhalation injury can effectively improve respiratory function. Doxycycline may play MMPs inhibitors and antagonistic cytokines role.