呼吸机相关性肺炎实施大剂量盐酸氨溴索治疗对其感染控制及病情预后的影响分析

Analysis on influence of implementing large dose of ambroxol hydrochloride on infection control and prognosis in ventilator associated pneumonia

目的探讨大剂量盐酸氨溴索治疗呼吸机相关性肺炎(VAP)对其感染控制情况及病情预后的影响,为临床用药方案的制定提供数据支撑。方法选取延安大学附属医院急危重症科2009年2月至2014年6月收治的VAP患者78例,采用随机数字表法进行分组,分别设为研究组和对照组,每组各39例。2组患者均开展常规对症支持治疗,即根据药敏试验结果给予相应抗生素、营养支持、氧疗等措施,研究组在此基础上采取大剂量盐酸氨溴索方案治疗,对照组则采取小剂量盐酸氨溴索方案治疗。比较2组患者在治疗前及治疗后第1、2周后炎性控制、病情预后及用药安全性情况。结果 2组治疗前白细胞计数、中性粒细胞分类、临床肺部感染(CPIS)评分及氧合指数差异无统计学意义(P>0.05);治疗后第1、2周后,研究组白细胞计数、中性粒细胞分类、CPIS评分均低于对照组,差异有统计学意义(P<0.05);氧合指数高于对照组,差异有统计学意义(P<0.05)。研究组住院时间及机械通气时间均短于对照组,差异有统计学意义(P<0.05),再次插管发生率及病死率均低于对照组,差异有统计学意义(P<0.05)。2组给药期间不良反应发生率差异无统计学意义(P>0.05)。结论大剂量盐酸氨溴索方案治疗VAP能有效改善其临床症状,利于炎性控制,且能降低病死率,值得在临床上进一步推广。

Objective To explore the influence of large dose of ambroxol hydrochloride in treating ventilator‐associated pneumonia（VAP） on the infection control and prognosis to provide the data support for formulating the clinical medication scheme .Methods 78 with VAP in the emergency department of our hospital from February 2009 to June 2014 were selected and divided into the study group and the control group by adopting the random number ta‐ble method ,39 cases in each group .Two groups were carried out the conventional symptomatic and supportive treat‐ment ,i .e .giving the corresponding measures of antibiotics ,oxygen therapy and nutrition support according to the re‐sults of drug susceptibility test .On this basis the study group took the large dose of ambroxol hydrochloride therapy , while the control group adopted the small dose of ambroxol hydrochloride therapy .Records of patients the inflamma‐tion control ,disease prognosis and medication safety situation before treatment and at the end of 1 ,2 weeks after treatment in the two groups were recorded for making a comparison .Results The white blodd cell count ,neutrophil classification ,clinic pulmonary infection score（CPIS） score and oxygenation index before treatment had no statistical difference between the two groups（P〉 0 .05） ;which at the end of 1 ,2 weeks after treatment in the study group were lower than the those in the control group（ P 〈0 .05） ,while the oxygen index was higher than that of the control group（P〈 0 .05） .The hospital stay and duration of mechanical ventilation in the study group were shorter than those in the control group（P〈 0 .05） ,moreover the reintubation incidence rate and mortality rate were lower than those in the control group（P〈0 .05） .The incidence rates of adverse reactions during medication period had no statistically significant difference between the two groups（P〉 0 .05） .Conclusion The large dose of ambroxol hydrochloride regi‐men for treating VAP can effectively improve the clinical symptoms ,conduces to the control of inflammation ,and can reduce the mortality rate and deserves to be popularized in clinic .