N-乙酰半胱氨酸治疗颅脑外伤后坠积性肺炎患者的临床研究

Effect of N-acetylcysteine in the treatment of patients with hypostatic pneumonia after craniocerebral trauma

目的探讨N-乙酰半胱氨酸(NAC)治疗颅脑外伤后并发坠积性肺炎患者的效果及对免疫功能的调节作用。方法将78例颅脑外伤后并发坠积性肺炎患者,分为试验组和对照组各39例。对照组给予基础的抗感染、吸氧、促排痰及支持治疗措施,试验组同时给予NAC,每次400 mg,每天3次。2组疗程均为3周。比较2组患者的体温恢复时间、咳嗽咳痰消失时间、肺部啰音消失时间。比较2组患者的外周血中T淋巴细胞、NK细胞、血清免疫球蛋白、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)水平;观察治疗过程中的药物不良反应发生情况。结果治疗后,试验组和对照组的体温恢复时间分别为(3.7±0.8),(4.3±1.0)d,咳嗽咳痰消失时间分别为(7.2±1.9),(8.4±2.0)d,肺部啰音消失时间分别为(5.7±1.5),(6.6±1.8)d,差异均有统计学意义(均P<0.05)。治疗后,试验组患者的CD3^+,CD4^+,CD8^+,CD4^+/CD8^+,NK细胞分别为(67.8±5.0)%,(41.0±3.0)%,(23.0±2.7)%,1.8±0.2,(27.6±3.2)%,对照组分别为(65.0±4.8)%,(38.8±3.4)%,(25.7±3.0)%,1.5±0.2,(25.3±3.4)%,差异均有统计学意义(均P<0.05)。治疗后,试验组和对照组的血清IgG分别为(12.61±0.80),(11.77±0.86)g·L^-1,PaO2分别为(91.04±4.08),(88.17±4.24)mmHg,PaCO2分别为(35.20±4.17),(37.61±4.04)mmHg,差异均有统计学意义(均P<0.05)。结论NAC治疗颅脑外伤后并发坠积性肺炎能更有效的缓解患者的临床症状、改善免疫功能水平及血气水平。

Objective To investigate the effect of NAC on patients with craniocerebral trauma and hypostatic pneumonia and its regulating effect on immune function.Methods A total of 78 patients with hypostatic pneumonia and craniocerebral trauma were divided into treatment group and control group,39 patients in each group.Control group was treated with oxygen,sputum promotion and supportive treatment measures,treatment group was treated with NAC 400 mg a time,3 times a day,at the same time.The treatment course of both groups were 3 weeks.The body temperature recovery time,cough and sputum disappearance time,lung snoring sound disappearance time between the two groups were compared.The levels of T lymphocytes,NK cells,serum immunoglobulin,partial pressure of oxygen pressure(PaO2)partial pressure of carbon dioxide(PaCO2)in two groups were observed.The adverse drug reactions were observed during the treatment.Results The temperature recovery time in treatment group and control group were(3.7±0.8),(4.3±1.0)d,cough and sputum disappearance time were(7.2±1.9),(8.4±2.0)d,lung snoring sound disappearance time were(5.7±1.5),(6.6±1.8)d,all with significant difference(all P<0.05).After treatment,the CD3^+,CD4^+,CD8^+,CD4^+/CD8^+and NK cells in treatment group were(67.8±5.0)%,(41.0±3.0)%,(23.0±2.7)%,1.8±0.2,(27.6±3.2)%,which in control group were(65.0±4.8)%,(38.8±3.4)%,(25.7±3.0)%,1.5±0.2,(25.3±3.4)%,all with significant difference(all P<0.05).After treatment,the serum IgG in treatment group and control group were(12.61±0.80),(11.77±0.86)g·L^-1 and PaO2 were(91.04±4.08),(88.17±4.24)mmH g,PaCO2 were(35.20±4.17),(37.61±4.04)mmH g,all with significant difference(all P<0.05).Conclusion NAC treatment of craniocerebral trauma complicated with hypostatic pneumonia can more effectively relieve the patient’s clinical symptoms,improve immune function and blood gas levels.