不同剂量沐舒坦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 different doses of ambroxol on extravascular lung water and oxygenation function in patients with extrapulmonary acute respiratory distress syndrome

目的探讨不同剂量沐舒坦对肺外型急性呼吸窘迫综合征(ARDS)患者血管外肺水及氧合功能的影响。方法选取2013年6月至2015年6月期间中山市南朗医院内科收治的100例肺外型ARDS患者作为研究对象,根据随机数字表法分为观察组和对照组各50例,在基础治疗的基础上,观察组采用大剂量的沐舒坦[20.0 mg/(kg·d)]溶解于100 m L生理盐水中静脉滴注,用药5 d。对照组采用常规剂量沐舒坦[7.5 mg/(kg·d)]溶解于100 m L生理盐水中静脉滴注,用药5 d。比较两组患者治疗前、治疗后3 d、5 d及7d的心脏指数(CI)、血管外肺水指数(ELWI)、血管通透性指数(PVPI)及氧合指数(Pa O2/Fi O2)的差异,以及机械通气时间、住院时间及死亡率的差异。结果治疗后3 d、5 d及7 d,观察组CI[(3.26±0.96)、(3.36±0.94)、(3.43±1.05)vs(3.04±0.82)、(3.19±0.87)、(3.22±0.93)]及Pa O2/Fi O2[(192±55)、(227±65)、(279±88)vs(165±46)、(197±54)、(237±62)]均显著高于对照组,EVWL[(7.96±1.93)、(7.53±1.96)、(6.53±1.56)vs(8.65±2.51)、(7.98±1.99)、(7.57±1.76)]及PVPI[(3.16±0.62)、(2.75±0.52)、(1.96±0.42)vs(3.75±0.62)、(3.25±0.77)、(2.73±0.71)]均显著低于对照组,差异具有统计学意义(P<0.05)。两组比较,观察组机械通气时间[(6.8±1.9)d vs(8.4±2.2)d]及住院时间更短[(27.5±7.6)d vs(33.1±8.5)d]、死亡率更低[(12.0)%(6/50)vs(32.0)%(16/50)],差异具有统计学意义(P<0.05)。结论大剂量沐舒坦(20.0 mg·kg-1·d-1)可以显著改善肺外型ARDS患者血管外肺水及氧合功能,值得临床推广应用。

Objective To investigate the effects of different doses of ambroxol on extravascular lung water and oxygenation function in patients with extrapulmonary acute respiratory distress syndrome(ARDS). Methods One hundred patients with extrapulmonary ARDS in Department of Internal Medicine, Zhongshan Nanlang Hospital from June2013 to June 2015 were selected as the research subjects. According to the random number table, the patients were divided into observation group and control group, with 50 patients in each group. On the basis of basic treatment, the observation group was treated with high dose ambroxol(20.0 mg/kg·d) for 5 d, which was dissolved in 100 m L saline for intravenous drip. The control group was treated with routine dose of ambroxol 7.5 mg/kg·d for 5 d, which was dissolved in100 m L saline for intravenous drip. The difference in cardiac index(CI), vascular permeability index(ELWI), blood vessel permeability index(PVPI), and oxygenation index(Pa O2/Fi O2) before treatment, 5 d, 3 d, 7 d after treatment were compared between the two groups. The difference in mechanical ventilation time, length of hospital stay and mortality were compared between the two groups. Results 3 d, 5 d and 7 d after treatment, CI [(3.26 ± 0.96),(3.36 ± 0.94),(3.43±1.05) vs(3.04 ± 0.82),(3.19 ± 0.87),(3.22 ± 0.93)] and Pa O2/Fi O2[(192 ± 55),(227 ± 65),(279 ± 88) vs(165 ± 46),(197 ± 54),(237 ± 62)] in the observation group were significantly higher than those in the control group, while EVWL[(7.96±1.93),(7.53±1.96),(6.53±1.56) vs(8.65±2.51),(7.98±1.99),(7.57±1.76)] and PVPI [(3.16±0.62),(2.75±0.52),(1.96±0.42) vs(3.75±0.62),(3.25±0.77),(2.73±0.71)] were significantly lower than those in control group. The differences were all statistically significant(P<0.05). In the two groups, the two groups had statistically significant difference in the time of mechanical ventilation [(6.8±1.9) vs(8.4±2.2)] and hospital stay [(27.5±7.6) vs(33.1±8.5)], as well as mortality [12.0%(6/50) vs 32.0%(16/50)], P<0.05. Conclusion High dose ambroxol(20.0 mg·kg-1·d-1) can significantly improve the vascular lung water and oxygenation function of the patients with extrapulmonary ARDS, which is worthy of clinical application.