CAJ | 학술논문

目的观察尼可地尔对急性呼吸窘迫综合征(ARDS)患者的临床疗效.方法采用前瞻性随机对照研究方法,选择2012年10月至2014年10月贵州省人民医院重症医学科收治的ARDS患者40例,按完全随机原则分为观察组和对照组,每组20例.两组入院后均给予西医常规治疗,在此基础上,观察组给予尼可地尔10 mg 胃管注入,对照组给予温开水10 mL胃管内注入;两组均每日3次,连用5 d.观察两组治疗后重症加强治疗病房(ICU)住院时间、机械通气时间,比较两组治疗前后氧合指数(OI)、肺泡动脉氧分压差(PA-aO2)、呼气末正压(PEEP)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷评分(GCS)、预期死亡风险(PDR)及28 d病死率的差异.采用二元logistic回归分析影响ARDS患者28 d病死率的预测因子.结果对照组ICU住院时间、机械通气时间较观察组延长,但差异均无统计学意义〔ICU住院时间(d):14.55±12.71比9.15±6.00,机械通气时间(d):13.25±12.27比7.75±5.32,均P>0.05〕.对照组和观察组治疗后GCS评分均较治疗前升高(分:11.95±3.98比10.75±4.89,12.95±3.67比12.20±4.56), APACHEⅡ评分、PDR、PEEP均较治疗前降低〔APACHEⅡ(分):21.05±8.58比24.90±5.63,18.70±11.21比 26.65±7.67;PDR:(47.71±29.49)% 比(61.00±23.29)%,(36.79±18.49)% 比(56.12±18.16)%;PEEP (cmH2O,1 cmH2O=0.098 kPa):4.40±3.14比5.75±2.59,3.80±2.55比7.55±3.32〕,但两组治疗前后同时间点比较差异无统计学意义(均P>0.05).两组治疗后OI均较治疗前明显升高,PA-aO2均较治疗前明显降低,且以观察组的改善程度较对照组更显著〔OI(mmHg,1 mmHg=0.133 kPa):224.72±85.12比141.37±45.82, PA-aO2(mmHg):132.60±46.64比204.30±121.2,均P<0.05〕.观察组28 d病死率较对照组降低,但两组比较差异无统计学意义〔15%(3/20)比25%(5/20),χ2=0.156,P>0.050).二元logistic回归分析显示,治疗后 PA-aO2〔优势比(OR)=0.958,P=0.013,95%可信区间(95%CI)=0.927~0.991〕、APACHEⅡ评分(OR=0.882, P=0.010,95%CI=0.803~0.970)、GCS评分(OR=1.399,P=0.004,95%CI=1.111~1.761)、PDR(OR=0.907, P=0.002,95%CI=0.853~0.965)是患者28 d病死率的独立预测因子.结论尼可地尔可以改善ARDS患者的氧合,但不能降低患者的28 d病死率. 目的觀察尼可地爾對急性呼吸窘迫綜閤徵(ARDS)患者的臨床療效.方法採用前瞻性隨機對照研究方法,選擇2012年10月至2014年10月貴州省人民醫院重癥醫學科收治的ARDS患者40例,按完全隨機原則分為觀察組和對照組,每組20例.兩組入院後均給予西醫常規治療,在此基礎上,觀察組給予尼可地爾10 mg 胃管註入,對照組給予溫開水10 mL胃管內註入;兩組均每日3次,連用5 d.觀察兩組治療後重癥加彊治療病房(ICU)住院時間、機械通氣時間,比較兩組治療前後氧閤指數(OI)、肺泡動脈氧分壓差(PA-aO2)、呼氣末正壓(PEEP)、急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、格拉斯哥昏迷評分(GCS)、預期死亡風險(PDR)及28 d病死率的差異.採用二元logistic迴歸分析影響ARDS患者28 d病死率的預測因子.結果對照組ICU住院時間、機械通氣時間較觀察組延長,但差異均無統計學意義〔ICU住院時間(d):14.55±12.71比9.15±6.00,機械通氣時間(d):13.25±12.27比7.75±5.32,均P>0.05〕.對照組和觀察組治療後GCS評分均較治療前升高(分:11.95±3.98比10.75±4.89,12.95±3.67比12.20±4.56), APACHEⅡ評分、PDR、PEEP均較治療前降低〔APACHEⅡ(分):21.05±8.58比24.90±5.63,18.70±11.21比 26.65±7.67;PDR:(47.71±29.49)% 比(61.00±23.29)%,(36.79±18.49)% 比(56.12±18.16)%;PEEP (cmH2O,1 cmH2O=0.098 kPa):4.40±3.14比5.75±2.59,3.80±2.55比7.55±3.32〕,但兩組治療前後同時間點比較差異無統計學意義(均P>0.05).兩組治療後OI均較治療前明顯升高,PA-aO2均較治療前明顯降低,且以觀察組的改善程度較對照組更顯著〔OI(mmHg,1 mmHg=0.133 kPa):224.72±85.12比141.37±45.82, PA-aO2(mmHg):132.60±46.64比204.30±121.2,均P<0.05〕.觀察組28 d病死率較對照組降低,但兩組比較差異無統計學意義〔15%(3/20)比25%(5/20),χ2=0.156,P>0.050).二元logistic迴歸分析顯示,治療後 PA-aO2〔優勢比(OR)=0.958,P=0.013,95%可信區間(95%CI)=0.927~0.991〕、APACHEⅡ評分(OR=0.882, P=0.010,95%CI=0.803~0.970)、GCS評分(OR=1.399,P=0.004,95%CI=1.111~1.761)、PDR(OR=0.907, P=0.002,95%CI=0.853~0.965)是患者28 d病死率的獨立預測因子.結論尼可地爾可以改善ARDS患者的氧閤,但不能降低患者的28 d病死率.
목적 관찰니가지이대급성호흡군박종합정(ARDS)환자적림상료효.방법 채용전첨성수궤대조연구방법,선택2012년10월지2014년10월귀주성인민의원중증의학과수치적ARDS환자40례,안완전수궤원칙분위관찰조화대조조,매조20례.량조입원후균급여서의상규치료,재차기출상,관찰조급여니가지이10 mg 위관주입,대조조급여온개수10 mL위관내주입;량조균매일3차,련용5 d.관찰량조치료후중증가강치료병방(ICU)주원시간、궤계통기시간,비교량조치료전후양합지수(OI)、폐포동맥양분압차(PA-aO2)、호기말정압(PEEP)、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、격랍사가혼미평분(GCS)、예기사망풍험(PDR)급28 d병사솔적차이.채용이원logistic회귀분석영향ARDS환자28 d병사솔적예측인자.결과 대조조ICU주원시간、궤계통기시간교관찰조연장,단차이균무통계학의의〔ICU주원시간(d):14.55±12.71비9.15±6.00,궤계통기시간(d):13.25±12.27비7.75±5.32,균P>0.05〕.대조조화관찰조치료후GCS평분균교치료전승고(분:11.95±3.98비10.75±4.89,12.95±3.67비12.20±4.56), APACHEⅡ평분、PDR、PEEP균교치료전강저〔APACHEⅡ(분):21.05±8.58비24.90±5.63,18.70±11.21비 26.65±7.67;PDR:(47.71±29.49)% 비(61.00±23.29)%,(36.79±18.49)% 비(56.12±18.16)%;PEEP (cmH2O,1 cmH2O=0.098 kPa):4.40±3.14비5.75±2.59,3.80±2.55비7.55±3.32〕,단량조치료전후동시간점비교차이무통계학의의(균P>0.05).량조치료후OI균교치료전명현승고,PA-aO2균교치료전명현강저,차이관찰조적개선정도교대조조경현저〔OI(mmHg,1 mmHg=0.133 kPa):224.72±85.12비141.37±45.82, PA-aO2(mmHg):132.60±46.64비204.30±121.2,균P<0.05〕.관찰조28 d병사솔교대조조강저,단량조비교차이무통계학의의〔15%(3/20)비25%(5/20),χ2=0.156,P>0.050).이원logistic회귀분석현시,치료후 PA-aO2〔우세비(OR)=0.958,P=0.013,95%가신구간(95%CI)=0.927~0.991〕、APACHEⅡ평분(OR=0.882, P=0.010,95%CI=0.803~0.970)、GCS평분(OR=1.399,P=0.004,95%CI=1.111~1.761)、PDR(OR=0.907, P=0.002,95%CI=0.853~0.965)시환자28 d병사솔적독립예측인자.결론 니가지이가이개선ARDS환자적양합,단불능강저환자적28 d병사솔.
Objective To investigate the clinical effect of nicorandil for treatment of patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted. A total of 40 cases of patients with ARDS admitted to Department of Critical Care Medicine of Guizhou Provincial People's Hospital from October 2012 to October 2014 were enrolled, and they were randomly divided into two groups, 20 cases in each group. The two groups were treated with routine western medicine after admission. On this basis, the observation group was given nicorandil 10 mg, while the control group was given warm boiled water 10 mL, through gastric tubes 3 times a day, the therapeutic course being consecutive 5 days in both groups. The length of stay in intensive care unit (ICU), duration of mechanical ventilation after treatment, oxygenation index (OI), alveolo-arterial oxygen partial pressure difference (PA-aO2), positive end-expiratory pressure (PEEP), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Glasgow coma score (GCS) before and after treatment, the predicted death rate (PDR) and 28-day mortality were compared between the two groups. The predicitive factors for 28-day mortality were screened by binary logistic analysis.Results The length of stay in ICU and duration of mechanical ventilation of control group were longer than those of observation group, but the difference was not statistically significant [ICU length of stay (day): 14.55±12.71 vs. 9.15±6.00, duration of mechanical ventilation (day): 13.25±12.27 vs. 7.75±5.32, bothP > 0.05]. After treatment, the GCS was higher than that before treatment in control group and observation group (11.95±3.98 vs. 10.75±4.89, 12.95±3.67 vs. 12.20±4.56), while APACHE Ⅱ score, PDR and PEEP were all lower than those before treatment [APACHE Ⅱ: 21.05±8.58 vs. 24.90±5.63, 18.70±11.21 vs. 26.65±7.67; PDR: (47.71±29.49)% vs. (61.00±23.29)%, (36.79±18.49)% vs. (56.12±18.16)%; PEEP (cmH2O, 1 cmH2O = 0.098 kPa): 4.40±3.14 vs. 5.75±2.59, 3.80±2.55 vs. 7.55±3.32], but there were no statistically significant differences between the two groups before and after treatment (allP > 0.05). After treatment, the OI was significantly higher and the PA-aO2 was significantly lower than those before treatment in the two groups, and the degrees of improvement of the observation group were more remarkable than those of the control group [OI (mmHg, 1 mmHg = 0.133 kPa): 224.72±85.12 vs. 141.37±45.82, PA-aO2 (mmHg): 132.60±46.64 vs. 204.30±121.2, bothP < 0.05]. The 28-day mortality of observation group was lower than that of control group, but no statistically significant difference was seen [15% (3/20) vs. 25% (5/20),χ2 = 0.156,P > 0.05). Binary logistic regression analyses showed that the PA-aO2 [odds ratio (OR) = 0.958,P = 0.013, 95% confidence interval (95%CI) = 0.927 - 0.991], APACHE Ⅱ score (OR = 0.882,P = 0.010, 95CI = 0.803 - 0.970), GCS (OR = 1.399, P = 0.004, 95%CI = 1.111 - 1.761) and PDR (OR = 0.907,P = 0.002, 95%CI = 0.853 - 0.965) after treatment were the independent predictors of 28-day mortality.Conclusion Nicorandil can significantly improve oxygenation, but cannot reduce 28-day mortality in patients with ARDS.