机械通气辅以盐酸氨溴索对老年急性呼吸窘迫综合征患者动脉血气和细胞因子的影响

摘要

目的 探讨机械通气辅以盐酸氨溴索(沐舒坦)对老年急性呼吸窘迫综合征(ARDS)患者动脉血气和细胞因子的影响.方法 对56例老年ARDS患者进入ICU后给予抗炎、吸痰、脱水和营养支持治疗,随机分为两组,治疗组在机械通气等常规治疗的基础上给予盐酸氨溴索20 mg/kg+生理盐水250 mL缓慢(3 h)静脉滴注;对照组在机械通气的基础上给予生理盐水250 mL缓慢(3 h)静脉滴注,两组连用7 d观察各项指标.比较两组患者治疗前和治疗后7 d氧合指标(PaO2/FiO2)及血清TNF-α、IL-6及IL-10浓度的变化和差异.结果 治疗后7 d,治疗组动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、PaO2/FiO2和血清IL-10浓度明显下降(P<0.05),心率(HR)和血清TNF-α、IL-6浓度明显下降(P<0.05),与对照组比较,差异均有统计学意义(P<0.05);治疗组动脉血二氧化碳分压(PaCO2)和平均动脉压(MAP)与对照组比较,差异无统计学意义(P>0.05).结论 机械通气辅以盐酸氨溴索治疗可以改善老年ARDS患者的氧合,有效调节细胞因子的生成,提高疗效.%Objective To explore ihe effecls of mechanial venlilalion supplemenled mucosolvan on arterial blood gas and cylokines in elderly palienls wilh acule respiralory dislress syndrome (ARDS). Methods 56 elderly palienls wilh ARDS were randomLy divided inlo Iwo groups. Paliens in Irealmenl group were Irealed wilh mechanial venlilalion and mucosolvan + normal saline infusion, in conlrol group wilh mechanial venlilalion and normal saline infusion respectively for 7 days, while Iwo groups were Irealed wilh anli - inflammation, furosemide, suclion and nulrilional support. The changes and differences of oxygenalion indices and serum cylokines concenlralion were analyzed in Iwo groups of before and afler Irealmenl. Results The arterial blood gas indices of PaO2, SaO2, PaO2/FiO2 and ihe serum cencenlralion of IL - 10 in Irealmenl group improved significantly ( P < 0. 05 ) . HR and ihe serum cylokines concenlralion of TNF - a, IL - 6 in Irealmenl group decreased significantly ( P < 0. 05 ). Whereas ihe above indices were staliscally significant differences in Iwo groups ( P < 0. 05 ) . PaCO2 and MAP were did not change significantly ( P > 0. 05 ). Conclusion The trealment of mechanial venlilalion supplemenled mucosolvan can improve oxygenation and regulale cylokines of elderly palients wilh ARDS, thereby enhancing efficacy.