不同剂量盐酸氨溴索治疗急性呼吸窘迫综合征合并呼吸机相关性肺炎的临床观察

目的:观察应用不同剂量盐酸氨溴索治疗急性呼吸窘迫综合征(ARDS)合并呼吸机相关性肺炎(VAP)的临床疗效和安全性。方法:回顾性分析我院124例ARDS合并VAP且使用盐酸氨溴索治疗的患者的临床资料,按照药物的应用剂量,将患者分为高剂量组(将300 mg盐酸氨溴索加入250 ml 0.9%氯化钠注射液中静脉滴注,bid)与低剂量组(将30 mg盐酸氨溴索加入250 ml0.9%氯化钠注射液中静脉滴注,bid),两组均为62例,疗程均为1周,且均给予相同的抗感染治疗和对症处理。比较两组患者治疗前后肺通气功能指标和细菌清除率,并观察不良反应情况。结果:治疗前两组患者肺通气功能各项指标比较差异均无统计学意义(P>0.05),而治疗后两组患者肺通气功能各项指标均较治疗前显著改善,且高剂量组患者的改善优于低剂量组,组内及组间比较差异均有统计学意义(P<0.05)。高剂量组患者细菌清除率显著高于低剂量组,组间比较差异有统计学意义(P<0.05)。所有患者均成功脱机,高剂量组患者机械通气的平均时间显著短于低剂量组,组间比较差异有统计学意义(P<0.05)。两组患者不良反应发生率比较差异无统计学意义(P>0.05)。结论:应用高剂量盐酸氨溴索治疗ARDS合并VAP相比应用低剂量盐酸氨溴索能够更显著地改善患者的肺通气功能,并能提高细菌清除率,缩短机械通气的时间,安全性相似。

Clinical Observation of Different Doses of Ambroxol Hydrochloride in the Treatment of Acute Respiratory Distress Syndrome Complicating with Ventilator-associated Pneumonia

OBJECTIVE：To observe the clinical efficacy and safety of different doses of ambroxol hydrochloride in the treatment of acute respiratory distress syndrome（ARDS）complicating with ventilator-associated pneumonia（VAP）. METHODS：The clinical data of 124 cases of ARDS complicating with VAP receiving ambroxol hydrochloride in our hospital were analyzed retrospectively. According to drug dose,the patients were divided into high dose group（intravenous infusion 300 mg ambroxol hydrochloride added into 0.9% Sodium chloride injection 250 ml,bid）and low dose group（intravenous infusion of 30 mg ambroxol hydrochloride added into 0.9% Sodium chloride injection 250 ml,bid）with 62 cases in each group. Treatment course of 2 groups lasted for 1 week,and both were given the same anti-infection treatment and symptomatic treatment. The pulmonary function indexes and bacterial clearance rate were compared between 2 groups before and after treatment,and the occurrence of ADR was observed.RESULTS：There was no statistical significance in pulmonary ventilation function indexes between 2 groups before treatment（P〉0.05）;while pulmonary ventilation function indexes of 2 groups were improved significantly,and the improvement of high dose group was better than that of low dose group;the intra and inter group differences were statistically significance（P〈0.05）. The bacterial clearance rate of high dose group was significantly higher than that of low dose group;there were statistically significant differences between 2 groups（P〈0.05）. All patients underwent successful offline,and the average time of mechanical ventilation in high dose group was significantly shorter in low dose group;there were statistically significant differences between 2 groups（P〈0.05）. There was no statistical significance in the incidence of ADR between 2 groups（P〈0.05）. CONCLUSIONS：High dose of ambroxol hydrochloride in better than low dose of ambroxol hydrochloride in the treatment of ARDS complicating with VAP in impro