硝酸甘油治疗急性呼吸窘迫综合征患者的临床分析

Effects of nitroglycerin on ARDS patients with low tidal volume ventilation strategies+pulmonary reexpansion after cardiopulmonary function,inflammatory factors and immune function

目的分析硝酸甘油对急性呼吸窘迫综合征(ARDS)患者小潮气量通气策略+肺复张术后心肺功能、炎症因子及免疫功能的影响。方法选择我院重症医学科2015年9月至2019年5月收治的98例ARDS患者随机分为硝酸甘油组50例、对照组48例,均实施小潮气量通气策略+肺复张术治疗,硝酸甘油组在此基础上给予静脉泵入硝酸甘油注射液治疗。分别于治疗前、治疗后6 h、24 h检测两组患者心肺功能、炎症因子及免疫功能相关指标水平。结果与治疗前比较,两组治疗后6 h、24 h左室射血分数、心脏指数(CI)明显升高,血清N-末端B型脑钠肽原(NT-proBNP)明显降低,且用力肺活量(FVC)、第1 s用力呼气容积(FEV1)、FEV1/FVC显著升高(P<0.05),两组6 h各项心肺功能指标比较无统计学意义(P>0.05),治疗后24 h硝酸甘油组心肺功能改善效果显著优于对照组(P<0.05)。与治疗前比较,两组治疗后6 h、24 h血清C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)水平均显著降低,CD3+、CD4+、CD4+/CD8+均显著增高(P<0.05),治疗后6 h、24 h硝酸甘油组CRP、PCT、IL-6水平均明显低于对照组,CD3+、CD4+、CD4+/CD8+均明显高于对照组(P<0.05)。结论在小潮气量通气策略+肺复张术基础上加用硝酸甘油治疗ARDS,可发挥更好的心肺功能保护作用,并可有效减轻炎症反应,增强免疫功能。

Objective To analysis of nitroglycerin on acute respiratory distress syndrome(ARDS)patients with low tidal volume ventilation strategies+pulmonary reexpansion after cardiopulmonary function,inflammatory factors and immune function.Methods From September 2015 to May 2019,98 patients with ARDS were randomly divided intoNitroglycerin group 50 cases and control group 48 cases.All patients were treated with small tidal volume ventilation strategy and pulmonary revascularization.The Nitroglycerin group was treated with intravenous nitroglycerin injection.The cardiopulmonary function,inflammatory factors and immune function associated indexes in the two groups were detected before treatment,6 h and 24 h after treatment.Results 6 h and 24 h after treatment,the left ventricular ejection fraction and cardiac index(CI)were significantly higher than those before treatment,serum N-terminal B type brain natriuretic peptide(NT-proBNP)levels were significantly lower than those before treatment,and the forced vital capacity(FVC),forced expiratory volume in 1 s(FEV1)and FEV1/FVC were significantly higher than those before treatment(P<0.05).6 h after treatment,there were no significant differences in cardiopulmonary function indexes between the two groups(P>0.05).24 h after treatment,the improvement of cardiopulmonary function in theNitroglycerin group was more significant than that in the control group(P<0.05).6 h and 24 h after treatment,the levels of serum C reactive protein(CRP),procalcitonin(PCT)and interleukin-6(IL-6)were significantly lower while the levels of CD3+,CD4+and CD4+/CD8+were significantly higher than those before treatment(P<0.05).6 h and 24 h after treatment,the levels of CRP,PCT and IL-6 in theNitroglycerin group were significantly lower while the levels of CD3+,CD4+and CD4+/CD8+were significantly higher than those in the control group(P<0.05).Conclusion Nitroglycerin combined with low tidal volume ventilation and lung recruitment maneuver in the treatment of ARDS can play a better role in protecting the cardiopulmonary function.The regimen can effectively relieve the inflammatory reactions and enhance immune function.