CAJ | 학술논문

目的观察多西环素对吸入性损伤患者的肺功能改善作用并探讨其机制。方法将22例重度吸入性损伤患者随机分为治疗组(n=12)和对照组(n=10)。两组均采取入住烧伤重症监护室,液体复苏,早期气管切开并应用呼吸机辅助呼吸,应用广谱抗生素防治感染,于气管切开前、切开后每1~2 d应用纤维支气管镜行局部灌洗等方法治疗,于住院后0、24、72、120 h测两组患者静脉血清中基质金属蛋白酶-2(MMP-2)、白介素-1β(IL-1β)含量；每12 h测动脉血气分析,计算两组的氧合指数(OI)=血氧分压(PaO2)/吸氧浓度(FiO2),记录乳酸值(LAC)。另治疗组常规经胃管注入多西环素片[第1天每12 h 1次2 mg/(kg·d),以后24 h 1次2 mg/(kg·d),共服用3 d],对照组经胃管注入安慰剂。比较两组的急性呼吸窘迫综合征(ARDS)发生率和死亡率,以及OI、LAC、MMP-2、IL-1β值。对计量资料采用t检验,计数资料用字2检验。结果两组患者7 d内ARDS发生率、死亡率差异无统计学意义(P>0.05),伤后72 h起治疗组较对照组OI值高(P<0.05), LAC值低(P<0.05),MMP-2、IL-1β低(P<0.05)。结论多西环素可改善吸入性损伤患者的呼吸功能,机制可能为发挥基质金属蛋白酶抑制剂和拮抗细胞因子作用。
목적관찰다서배소대흡입성손상환자적폐공능개선작용병탐토기궤제。방법장22례중도흡입성손상환자수궤분위치료조(n=12)화대조조(n=10)。량조균채취입주소상중증감호실,액체복소,조기기관절개병응용호흡궤보조호흡,응용엄보항생소방치감염,우기관절개전、절개후매1~2 d응용섬유지기관경행국부관세등방법치료,우주원후0、24、72、120 h측량조환자정맥혈청중기질금속단백매-2(MMP-2)、백개소-1β(IL-1β)함량；매12 h측동맥혈기분석,계산량조적양합지수(OI)=혈양분압(PaO2)/흡양농도(FiO2),기록유산치(LAC)。령치료조상규경위관주입다서배소편[제1천매12 h 1차2 mg/(kg·d),이후24 h 1차2 mg/(kg·d),공복용3 d],대조조경위관주입안위제。비교량조적급성호흡군박종합정(ARDS)발생솔화사망솔,이급OI、LAC、MMP-2、IL-1β치。대계량자료채용t검험,계수자료용자2검험。결과량조환자7 d내ARDS발생솔、사망솔차이무통계학의의(P>0.05),상후72 h기치료조교대조조OI치고(P<0.05), LAC치저(P<0.05),MMP-2、IL-1β저(P<0.05)。결론다서배소가개선흡입성손상환자적호흡공능,궤제가능위발휘기질금속단백매억제제화길항세포인자작용。
Objective To observe the effect of doxycycline tablets on acute respiratory distress syndrome following inhalation injury. Methods 22 burned patients with severe inhalation injury hospitalized from October 2007 to Oc-tober 2012, were divided into two groups,12 patients randomly entering treatment group and 10 patients entering control group. Patients in C group were treated with routine methods, including transferred to Burn Intensive Care Unit, fluid resuscitation based on the Third Military Medical University formula, anti infection treatment, early tra-cheostomy,mechanical ventilation,lung lavage by flexible fiberoptic bronchoscope,support treatment, and organ-protection treatment,etc. In addition to routine treatment methods,patients in T group received doxycycline tablets once a day [the intake was 4 mg/(kg·d) on the first day, on the second and third day the intake was 2 mg/(kg ·d)]. Venous blood of patients was drawn at post burn hour 0,24,72,and 120 to determine the serum levels of MMP-2, IL-1β. OI,LAC, and PEEP values were recorded twice a day. Data were processed with t test or Chi-square test. Results There was no difference in incidence of ARDS and mortality between the two groups (P>0.05). The levels of LAC, PEEP, MMP-2 and IL-1β were lower in T group than in C group after 72 hours. The level of OI was higher. Differences in contents of these parameters between two groups were statistically significant (P<0.05). Conclusion Early use of doxycycline tablets in patients following inhalation injury can effectively improve respiratory function. Doxycycline may play MMPs inhibitors and antagonistic cytokines role.