大剂量盐酸氨溴索联合纤支镜灌洗治疗老年重症肺炎疗效及对APACHEⅡ评分和氧合指数的影响

The efficacy of high-dose ambroxol hydrochloride combined with fiber bronchoscopic lavage in the treatment of elderly severe pneumonia and its effects on APACHEⅡscore and oxygenation index

目的探讨大剂量盐酸氨溴索联合纤维支气管镜(纤支镜)灌洗治疗老年重症肺炎的临床效果。方法本院接受治疗的老年重症肺炎患者92例,根据随机数字表法分为观察组和对照组各46例。对照组予以常规剂量盐酸氨溴索与振动排痰治疗,观察组予以大剂量盐酸氨溴索联合纤支镜灌洗治疗。比较两组临床疗效和预后指标,观察治疗前后急性生理性与慢性健康状况(APACHEⅡ)评分、血气分析指标、炎症指标等变化情况。结果观察组治疗总有效率高于对照组,呼吸机带机时间、住ICU时间短于对照组,MOF发生率、28 d死亡率低于对照组(P<0.05);治疗7 d后,两组APACHEⅡ评分及血清降钙素原、C反应蛋白、白细胞介素-6、可溶性细胞间黏附分子-1水平均较治疗前降低,且观察组低于对照组(P<0.05);两组PaO2、SaO2、PaO2/FiO2水平均较治疗前升高(P<0.05),组间PaO2、SaO2水平比较差异无统计学意义(P>0.05),观察组PaO2/FiO2水平高于对照组(P<0.05)。结论大剂量盐酸氨溴索联合纤支镜灌洗治疗老年重症肺炎效果显著,可明显改善血气指标,抑制炎症反应,促进疾病转归,降低病死率。

Objective To explore the clinical effects of high-dose ambroxol hydrochloride combined with fiber bronchoscopic lavage in the treatment of elderly severe pneumonia.Methods A total of 92 elderly patients with severe pneumonia who were treated in our hospital were selected and divided into observation or control group according to the random number table method,46 in each group.The control group was treated with conventional-dose ambroxol hydrochloride and vibration expectoration,and the observation group was treated with high-dose ambroxol hydrochloride combined with fiber bronchoscopic lavage.The clinical efficacy and prognostic indicators were compared between the two groups.The acute physiological and chronic health evaluation(APACHEⅡ)score,blood gas analysis indicators and inflammation indicators were observed before and after treatment.Results The total effective rate of treatment was higher,the ventilator take-up time and ICU stay were shorter and the incidence rate of MOF and 28 day mortality rate were lower in the observation group than those in the control group(P<0.05).After 7 days of treatment,the APACHEⅡscore and levels of serum PCT,CRP,IL-6 and sICAM-1 were decreased compared with those before treatment,and the indexes in the observation group were lower than those in the control group(P<0.05).After 7 days of treatment,the levels of PaO2,SaO2 and PaO2/FiO2 in the two groups were increased compared with those before treatment(P<0.05),and there were no significant differences in PaO2 and SaO2 between the groups(P>0.05)while the PaO2/FiO2 in the observation group was higher than that in the control group(P<0.05).Conclusion High-dose ambroxol hydrochloride combined with fiber bronchoscopic lavage has significant effects in the treatment of elderly severe pneumonia.It can significantly improve the blood gas indicators,inhibit the inflammatory response,promote the disease outcomes and reduce the mortality rate.