大剂量氨溴索联合气管镜治疗高位截瘫患者肺部感染临床研究

目的观察大剂量氨溴索联合纤支镜在治疗高位截瘫患者合并肺部感染的临床效果。方法合并严重肺部感染的高位截瘫患者30例，随机分成3组：小剂量氨溴索组（氨溴索30mg，壶入3次／d）；大剂量氨溴索组（氨溴索300mg，壶入3次／d）；联合治疗组（氨溴索300mg，壶入3次，d），联合纤支镜下吸痰治疗。比较各组患者治疗前以及治疗第3d，第7d的临床效果、体征、X线表现、血气分析及呼吸机使用时间等。结果大剂量组患者在临床效果、体征及X线表现好转程度明显优与小剂量组（均P〈0．05），且感染控制及脱机时间均显示缩短。联合治疗组较大剂量组治疗效果更加明显。结论对高位截瘫合并肺部感染患者，应用大剂量氨溴索可以有效化痰，控制感染，减少控制感染时间，减少呼吸机辅助呼吸时间，联合纤支镜治疗效果更好。

Effects of high-dose ambroxol combined with fiberoptic bronchoscopy in treatment of high level paraplegia complicated with pulmonary infection: clinical analysis of 30 cases

Objective To explore the effects of high-dose mucosolvan combined with fiberoptic bronchoscopy in treatment of high level paraplegia complicated with pulmonary infection. Methods Thirty high level paraplegia patients with pulmonary infection, aged 34-52, were randomly divided into 3 groups： low-dose ambroxol group undergoing intravenous infusion of ambroxol, a mucosolvan, at the dose of 30 mg （normal dose） via Murphy＇ s dropper, tid; high-dose ambroxol group undergoing intravenous infusion of ambroxol at the dose of 300 mg tid; and group of high-dose ambroxol combined with sputum suctioning by fiberoptic bronchoscopy, undergoing intravenous infusion of ambroxol at the dose of 300 mg tid and sputum suctioning by fiberoptic bronchoscopy once a day at beginning, then every other day, and even being separated from the suction apparatus at last. The clinical symptoms, physical signs, X-ray display, arterial blood gas analysis, and mechanical ventilation time were recorded and compared before the treatment, and 3d and 7d after the treatment. Results The improvement rates in symptoms, signs, and X-ray imaging 7d after treatment of the combined treatment group were all significantly higher than those of the low-dose and high-dose ambroxol groups （all P〈0.05）. The temperature and white blood cell level returned to normal quicker in the combined treatment than in the other 2 groups （both P〈0.05）, and similarly the temperature and white blood cell level returned to normal quicker in the high-dose ambroxol group than in the low-dose ambroxol group （both P〈0.05）. The mechanical ventilation time of the combined treatment group was （8.6±2,1） days, significantly shorter than those of the high-dose and low-dose ambroxol groups （12.3±1.2） and （15.8 ±4.6） days respectively, both P〈0.05], and the mechanical ventilation time of the high-dose ambroxol group was significantly shorter than that of the low-dose ambroxol group too （P〈0.05）. The PaO2, PaO2/FiO2, and SaO2 levels of the combined treatment group were all significantly higher than those of the low-dose ambroxol group （all P〈0.05）. and the PaO2/FiO2 level of the high-dose ambroxol group was significantly higher than that of the low-dose group （P〈0.05）. Conclusion High-dose mueosolvan combined with fiberoptic bronchoscopy is effective in treatment of high level paraplegia patients with pulmonary infection.