大剂量盐酸氨溴索对肺外型急性呼吸窘迫综合征患者血管外肺水及氧合功能的影响

Effect of high dose ambroxol hydrochloride on the extra-vascular lung water and oxygenation of patients with extra-pulmonary acute respiratory distress syndrome

目的研究大剂量盐酸氨溴索对肺外型急性呼吸窘迫综合征(ARDS)患者血管外肺水(ELWI)及氧合功能的影响。方法将68例符合ARDS诊断标准的患者分为治疗组(35例)与对照组(33例)。治疗组予以盐酸氨溴索1005 mg/d静脉注入,3 h完成,对照组予以等容量的生理盐水静脉滴注3 h,连续治疗7 d。比较两组患者治疗前、治疗后3、5、7 d动脉氧分压和氧饱和度(SaO2),氧合指数、心脏指数(CI)、血管外肺水指数(ELWI)和血管通透性指数(PVPI)的变化以及机械通气时间、停留ICU时间、住院时间。结果两组患者治疗后动脉氧分压、SaO2以及氧合指数均有不同程度的升高,ELWI、PVPI均有下降,且治疗组在治疗后5、7 d较对照组改善更为明显(P均<0.05)。此外,治疗组患者机械通气时间、停留ICU时间以及住院时间均比对照组显著降低(P均<0.05)。结论大剂量盐酸氨溴索可以降低ARDS患者肺血管通透性及血管外肺水,改善氧合功能,降低机械通气时间和住院时间。

Objective To evaluate the effect of high dose ambroxol on the extra-vascular lung water and oxygenation of patients with extra-pulmonary acute respiratory distress syndrome （ARDS）. Methods A total of 68 patients suffered from ARDS were randomly divided into the treatment group （35 cases） and control group （33 cases）. Patients in the treatment group received high dose ambroxol （1005 mg/d, for 3 h） intravenous and patients in the control group receivedequal volume of 0.9% NaC1 intravenously for 7 consecutive days. The cardiac index （CI）, extra-vascular lung water index （ELWI）, pulmonary vascular permeability index （PVPI） were observed by pulse indicator continuous cardiac output （PiCCO） and partial pressure of oxygen, oxygen saturation （Sa02） and oxygenation index were measured by blood gas analysis before andon days 3, 5 and 7 after treatment. Mechanical ventilation time, intensive care unit （ICU） length of stay and hospitalization duration were recorded and compared between the two groups. Results The partial pressure of oxygen, SaO2 and oxygenation index were higher, the levels of ELWI and PVPI were lower after the treatment in the two groups and these indices in the treatment group on days 5 and 7 showed significant differences as compared with those in the control group （all P 〈 0.05）. Meanwhile, mechanical ventilation time, ICU length of stay and hospitalization duration in the treatment group also decreased markedly compare with those in the control group. Conclusion High dose ambroxol can decrease ELWI and PVPI, and improve oxygenation function in patients with extra-pulmonary ARDS.