中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2013年
7期
723-726
,共4页
包龙%徐峰%丁礼%凌伟华
包龍%徐峰%丁禮%凌偉華
포룡%서봉%정례%릉위화
氨溴索%颅脑损伤%肿瘤坏死因子α
氨溴索%顱腦損傷%腫瘤壞死因子α
안추색%로뇌손상%종류배사인자α
Ambroxol%Mild hypothermia%Craniocerebral trauma%Tumor necrosis factor alpha
目的 探讨大剂量盐酸氨溴索对亚低温治疗老年颅脑损伤患者的肺保护及抗炎作用.方法 收集我院重症监护室2008年6月至2012年6月收治的亚低温治疗老年颅脑损伤患者共40例,年龄60～～72岁,平均(65.3±4.3)岁.使用简单随机分组分为盐酸氨溴索小剂量组与大剂量组,每组20例.小剂量组在机械通气,抗生素等常规治疗的基础上给予盐酸氨溴索30 mg+生理盐水100ml慢静脉滴注；大剂量组在常规基础上给予盐酸氨溴索300 mg+生理盐水100 ml慢静脉滴注,3次/d,两组连用7d.比较两组患者痰液性状、痰液量、氧分压、氧合指数、及肿瘤坏死因子α(TNF-α)的变化,比较两组患者病程中带机时间、气切比例,随访3个月,比较两组患者的病死率. 结果 治疗3～～7d后,大剂量组较小剂量组痰液性状明显稀薄(75％比40％,P=0.025),一次吸净率明显升高(65％比25％,P=0.011),PaO2和PaO2/FiO2均较小剂量组改善[PaO2∶3 d(92.3±12.3) mmHg比(83.3±15.2) mm Hg,P=0.046;7 d(95.9±12.5) mm Hg比(87.1±11.7) mm Hg,P=0.028;PaO2/FiO2∶3 d(290.8±15.8) mm Hg比(221.8±16.4) mm Hg,P=0.000;7 d(296.3±16.9) mm Hg比(238.4±15.0)mm Hg,P=0.000],且大剂量组患者血浆TNF-α水平低于小剂量组[3 d (54.1±4.9) ng/L比(71.4±5.6) ng/L,P=0.000;7 d(35.1±2.7) ng/L比(63.3±4.3)ng/L,P=0.000].大剂量组带机时间较小剂量组明显缩短[(116.8±18.7)h比(178.4±35.5)h,P=0.000],气切比例明显较少(25％比60 ％,P=0.025).两组患者病死率差异无统计学意义. 结论 亚低温治疗老年颅脑损伤患者期间应用大剂量盐酸氨溴索具有较强的肺保护作用,改善呼吸功能,缩短带机时间,减少气切比例,并且可以降低全身炎性反应,但是对患者长期生存无帮助.
目的 探討大劑量鹽痠氨溴索對亞低溫治療老年顱腦損傷患者的肺保護及抗炎作用.方法 收集我院重癥鑑護室2008年6月至2012年6月收治的亞低溫治療老年顱腦損傷患者共40例,年齡60～～72歲,平均(65.3±4.3)歲.使用簡單隨機分組分為鹽痠氨溴索小劑量組與大劑量組,每組20例.小劑量組在機械通氣,抗生素等常規治療的基礎上給予鹽痠氨溴索30 mg+生理鹽水100ml慢靜脈滴註；大劑量組在常規基礎上給予鹽痠氨溴索300 mg+生理鹽水100 ml慢靜脈滴註,3次/d,兩組連用7d.比較兩組患者痰液性狀、痰液量、氧分壓、氧閤指數、及腫瘤壞死因子α(TNF-α)的變化,比較兩組患者病程中帶機時間、氣切比例,隨訪3箇月,比較兩組患者的病死率. 結果 治療3～～7d後,大劑量組較小劑量組痰液性狀明顯稀薄(75％比40％,P=0.025),一次吸淨率明顯升高(65％比25％,P=0.011),PaO2和PaO2/FiO2均較小劑量組改善[PaO2∶3 d(92.3±12.3) mmHg比(83.3±15.2) mm Hg,P=0.046;7 d(95.9±12.5) mm Hg比(87.1±11.7) mm Hg,P=0.028;PaO2/FiO2∶3 d(290.8±15.8) mm Hg比(221.8±16.4) mm Hg,P=0.000;7 d(296.3±16.9) mm Hg比(238.4±15.0)mm Hg,P=0.000],且大劑量組患者血漿TNF-α水平低于小劑量組[3 d (54.1±4.9) ng/L比(71.4±5.6) ng/L,P=0.000;7 d(35.1±2.7) ng/L比(63.3±4.3)ng/L,P=0.000].大劑量組帶機時間較小劑量組明顯縮短[(116.8±18.7)h比(178.4±35.5)h,P=0.000],氣切比例明顯較少(25％比60 ％,P=0.025).兩組患者病死率差異無統計學意義. 結論 亞低溫治療老年顱腦損傷患者期間應用大劑量鹽痠氨溴索具有較彊的肺保護作用,改善呼吸功能,縮短帶機時間,減少氣切比例,併且可以降低全身炎性反應,但是對患者長期生存無幫助.
목적 탐토대제량염산안추색대아저온치료노년로뇌손상환자적폐보호급항염작용.방법 수집아원중증감호실2008년6월지2012년6월수치적아저온치료노년로뇌손상환자공40례,년령60～～72세,평균(65.3±4.3)세.사용간단수궤분조분위염산안추색소제량조여대제량조,매조20례.소제량조재궤계통기,항생소등상규치료적기출상급여염산안추색30 mg+생리염수100ml만정맥적주；대제량조재상규기출상급여염산안추색300 mg+생리염수100 ml만정맥적주,3차/d,량조련용7d.비교량조환자담액성상、담액량、양분압、양합지수、급종류배사인자α(TNF-α)적변화,비교량조환자병정중대궤시간、기절비례,수방3개월,비교량조환자적병사솔. 결과 치료3～～7d후,대제량조교소제량조담액성상명현희박(75％비40％,P=0.025),일차흡정솔명현승고(65％비25％,P=0.011),PaO2화PaO2/FiO2균교소제량조개선[PaO2∶3 d(92.3±12.3) mmHg비(83.3±15.2) mm Hg,P=0.046;7 d(95.9±12.5) mm Hg비(87.1±11.7) mm Hg,P=0.028;PaO2/FiO2∶3 d(290.8±15.8) mm Hg비(221.8±16.4) mm Hg,P=0.000;7 d(296.3±16.9) mm Hg비(238.4±15.0)mm Hg,P=0.000],차대제량조환자혈장TNF-α수평저우소제량조[3 d (54.1±4.9) ng/L비(71.4±5.6) ng/L,P=0.000;7 d(35.1±2.7) ng/L비(63.3±4.3)ng/L,P=0.000].대제량조대궤시간교소제량조명현축단[(116.8±18.7)h비(178.4±35.5)h,P=0.000],기절비례명현교소(25％비60 ％,P=0.025).량조환자병사솔차이무통계학의의. 결론 아저온치료노년로뇌손상환자기간응용대제량염산안추색구유교강적폐보호작용,개선호흡공능,축단대궤시간,감소기절비례,병차가이강저전신염성반응,단시대환자장기생존무방조.
Objective To explore the effects of high-dose ambroxol hydrochloride (Mucosolvan) on pulmonary protection and anti-inflammatory in traumatic brain injury patients treated by mild hypothermia.Methods From June 2008 to June 2012,40 elderly traumatic brain injury patients aged 60-70 years treated by mild hypothermia in our hospital were selected.Patients were randomly divided into two groups:low-dose ambroxol hydrochloride group and high dose ambroxol hydrochloride (n=20,each).Patients in low-dose ambroxol hydrochloride group were treated with ambroxol 30 mg plus saline infusion,3 times/day; while patients in high-dose ambroxol hydrochloride group were treated with ambroxol 300mg plus saline infusion,3 times/day; both groups were treated for 7 days.The changes of characteristic and quantity of sputum,PaO2and PaO2/FiO2,and serum TNF α level were analyzed at day 1,3,7.Duration of mechanical ventilation,tracheotomy proportion,and mortality were compared between the two groups 3 months after treatment.Results At day 3-7 after the intervention,the sputum got thinner and less,and more easy to suck in highdose group than in low-dose group (thin sputum proportion:75％ vs.40％,P =0.025; clean proportion by once suction:65％ vs.25％,P=0.011).The improvement of PaO2,PaO2/FiO2 were more significant in high dose group than in low dose group (PaO2 ∶ 3d,(92.3±12.3) mm Hg vs.(83.3±15.2) mm Hg,P=0.046;7d,(95.9±12.5) mm Hgvs.(87.1±11.7) mm Hg,P=0.028;PaO2/FiO2∶3d,(290.8± 15.8) mmHgvs.(221.8± 16.4) mm Hg,P=0.000;7d,(296.3±16.9)mm Hg vs.(238.4±15.0) mm Hg,P=0.000).Serum concentrations of TNF α was lower in highdose group than in low dose group [3d,(54.1± 4.9) ng/L vs.(71.4± 5.6) ng/L,P=0.000;7d,(35.1± 2.7) ng/L vs.(63.3±4.3) ng/L,P 0.000].Duration of mechanical ventilation was shorter and tracheotomy proportion was lower in high dose group than in low dose group [(116.8±18.7) hrsvs.(178.4±35.5) hrs,P=0.000; 25％ vs.60％,P=0.025].There was no significant difference in mortality between groups 3 months after treatment.Conclusions The application of high dose ambroxol can improve respiratory function,decrease duration of mechanical ventilation and tracheostomy proportion,and reduce the systemic inflammatory response in elderly traumatic brain injury patients treated by mild hypothermia,but without long-term survival benefit.
