目的 探讨大剂量氨溴索联合亚胺培南治疗行机械通气的高龄重症肺炎患者的疗效及安全性。方法 选择2019-06至2023-06火箭军特色医学中心ICU收治的86例高龄(≥80岁)重症肺炎机械通气患者,采取随机数字表法,分为两组,对照组40例,采用常规剂量氨溴索联合亚胺培南治疗;研究组46例,采用大剂量氨溴索[15 mg/(kg·d)]联合亚胺培南治疗。比较两组患者治疗后临床疗效,包括肺部影像学表现、机械通气时间和住ICU时间,急性生理功能和慢性健康状况评分系统评分(APACHE Ⅱ),全身性感染相关性功能衰竭评分(SOFA),临床肺部感染评分(CPIS),炎症因子变化以及不良反应发生情况等。结果 与对照组相比,研究组机械通气时间较短[(8.15±1.31)d vs.(7.13±1.53)d,P<0.05],胸片阴影消失时间较快[(7.80±1.02)d vs.(6.61±0.97)d,P<0.05],住ICU时间较短[(16.25±1.78)d vs.(14.37±2.15)d,P<0.05],病灶吸收率较高[(65.95±7.73)% vs.(78.96±9.11)%,P<0.05]。治疗后研究组较对照组APACHE Ⅱ[(7.17±1.07)vs.(8.25±1.12),P<0.05]、SOFA[(3.15±0.51)vs.(4.21±0.96),P<0.05]、CPIS[(3.18±0.89) vs.(3.80±0.75),P<0.05]、降钙素原[(0.16±0.07)μg/L vs.(0.25±0.12)μg/L,P<0.05]、C-反应蛋白[(5.15±3.11)mg/L vs.(8.51±2.96)mg/L,P<0.05]、白细胞介素6[(15.28±9.89)ng/L vs.(25.20±1.75)ng/L,P<0.05]水平下降更快。在观察期内,两组患者的不良反应发生率无统计学差异(P＞0.05)。结论 大剂量氨溴索联合亚胺培南治疗行机械通气的高龄重症肺炎患者,能缩短机械通气和住ICU时间,且安全性良好。
Abstract
Objective To investigate the efficacy and safety of high-dose ambroxol combined with imipenem in the treatment of elderly patients with severe pneumonia treated by mechanical ventilation. Methods A total of 86 elderly (≥80 years old) patients with severe pneumonia admitted to ICU of Characteristics Medical Center of PLA Rocket Force from June 2019 to June 2023 were divided into two groups by random number table method, they were divided into two groups. The control group included 40 patients who received conventional-dose ambroxol combined with imipenem treatment, while the study group included 46 patients who received high-dose ambroxol [15 mg/(kg·d)] combined with imipenem treatment. The efficacy of the two groups was compared after treatment, including lung imaging, duration of mechanical ventilation, length of ICU stay. APACHE Ⅱ, SOFA, CPIS, changes in inflammatory factors and adverse reactions. Results Compared with the control group, the duration of mechanical ventilation of the study group was shorter[(8.15±1.31)d vs. (7.13±1.53)d, P<0.05],disappearance time of shadow on chest radiograph was faster[(7.80±1.02)d vs. (6.61±0.97)d, P<0.05]. The duration of ICU stay was shorter [(16.25±1.78)d vs. (14.37±2.15)d, P<0.05], and the lesion absorption rate was higher[(65.95±7.73)% vs. (78.96±9.11)%, P<0.05]. After treatment, APACHE Ⅱ [(7.17±1.07) vs. (8.25±1.12), P<0.05], SOFA [(3.15±0.51) vs. (4.21±0.96), P<0.05], CPIS[(3.18±0.89) vs. (3.80±0.75), P<0.05], PCT[(0.16±0.07) μg/L vs. (0.25±0.12)μg/L, P<0.05], CRP[(5.15±3.11)mg/L vs. (8.51±2.96)mg/L, P<0.05], IL-6 [(15.28±9.89) ng/L vs. (25.20±1.75) ng/L, P<0.05]of the study group decreased faster. There was no significant difference in the incidence of adverse reactions between the two groups during the observation period (P>0.05). Conclusions High-dose ambroxol combined with imipenem in the treatment of elderly patients with severe pneumonia treated by mechanical ventilation can shorten the duration of mechanical ventilation and ICU stay, and the safety is good.
关键词
重症肺炎 /
机械通气 /
大剂量氨溴索 /
亚胺培南 /
炎症因子
Key words
severe pneumonia /
mechanical ventilation /
high-dose ambroxol /
imipenem /
inflammatory factor
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