Objective To investigate the application value of combination of ambroxol and fluidmicronized ipratropium bromide in full dose and frequency in treating senile refractory pneumonia.Methods From January 2010 to November 2013,84 cases of elderly patients with refractory pneumonia were divided into 3 groups.On the basis of anti-inflammatory and symptomatic treatment,the control group (n=28) received routine sputum suction and normal saline irrigation;the routine dose group (n=28) received the intravenous ambroxol 15 mg twice daily and the inhalation of 2.5 ml of nebulized ipratropium bromide once daily plus treatment in control group while full dose group (n=28) received intravenous ambroxol hydrochloride 30 mg three times a day and the inhalation of 2.5 ml of nebulized ipratropium bromide four times a day.The severity of pulmonary infection was described by clinical pulmonary infection score (CPIS) and C reactive protein (CRP),and therapeutic efficiency was evaluated by clinical symptom remission time,average hospitalization days and effective rate.Results At the 5 day and 10 days after treatment,the CPIS in full dose group was (4.82 ± 1.21) scores and (4.39± 1.03),respectively,C-reactive protein (CRP) was (58.11 ± 11.12) mg/L and (57.57±12.69) mg/L respectively,and these CPIS and CRP values at the 5 day and 10 days were significantly lower than those in the control group (6.10 ± 1.10) scores and (5.36 ± 0.95) scores,(74.50± 12.79)mg/L and (68.46± 13.77) mg/L (all P＜0.05).The above Values were lower as compared with those [(5.43±0.84) and (5.21 ±0.83),(65.11 ±834) mg/L and (59.11± 13.77) mg/L (P＜ 0.05)] in routine dose group.The CPIS and CRP concentration in full dose group and routine dose group were lower at the 10 days than at the 5 days (P＜0.05).Besides,clinical symptom remission time (4.43 ± 1.75) days,average hospitalization duration(26.32 ± 4.92) days in full dose group,clinical symptom remission time (5.68 ± 2.29) day,average hospitalization (32.21 ± 5.63) days in conventional dose group were significantly lower than in the control group (7.79±2.74) and (36.71 ± 11.78) days (P ＜ 0.05).Clinical manifestation,time of remission,and average hospitalization days of the full dose group were also reduced as compared with the conventional dose group (P＜0.05).The efficiency rates in the three groups of control,conventional dose and full dose were 42.9％ (12/28),71.4％ (20/28),92.9％ (26/28),among which the efficiency of full dose group was significantly higher than those of the control group and the conventional dose group,(x2 =16.047,6.788,P＜0.01).The conventional dose group showed a higher efficiency than the control group (x2 =4.667,P ＜ 0.01).Conclusions Combination of ambroxol and fluid-micronized ipratropium bromidet in full dose and frequency for treating senile refractory pneumonia is a useful managemen in the elderly patients.%目的 探讨足剂量、足频率静脉滴注盐酸氨溴索联合复方异丙托溴铵雾化吸入治疗老年人难治性肺炎的应用价值.方法 2010年1月至2013年11月老年难治性肺炎患者84例,按不同治疗方法将患者分为3组,均给予抗炎及对症治疗.其中对照组28例常规吸痰及生理盐水冲洗;常规剂量组28例在对照组的基础上,给予静脉滴注盐酸氨溴索15 mg,2次/d,复方异丙托溴铵雾化吸入2.5 ml,1次/d;足剂量组28例在对照组基础上,应用足剂量盐酸氨溴索注射液30 mg,2次/d,复方异丙托溴铵雾化吸入2.5ml,4次/d.肺部感染的严重程度采用临床肺部感染评分(CPIS)和C反应蛋白(CRP)进行描述,治疗效果以临床症状缓解时间、平均住院日及有效率进行评价.结果 足剂量组的CPIS浓度治疗第5天和第10天分别为(4.82±1.21)分和(4.39±1.03)分、CRP分别为(58.11±11.12) mg/L和(50.57±12.69) mg/L,均明显低于对照组的(6.10±1.10)分和(5.36±0.95)分、(74.50± 12.79)mg/L和(68.46±13.77)mg/L(均P＜0.05);较常规剂量组的(5.43±0.84)分和(5.21±0.83)分、(65.11±8.34)mg/L和(59.11±13.77) mg/L亦明显降低(均P＜0.05);足剂量组和常规剂量组治疗第10天的CPIS和CRP浓度较第5天明显下降(均P＜0.05).足剂量组患者的临床症状缓解时间、平均住院日分别为(4.43±1.75)d和(26.32±4.92)d,常规剂量组为(5.68±2.29)d和(32.21±5.63)d,均明显低于对照组(7.79±2.74)d和(36.71±11.78)d(F=6.675、5.166,P=0.016、0.008);足剂量组的临床症状缓解时间、平均住院日较常规剂量组相比较亦明显降低(均P＜0.05).对照组、常规剂量组和足剂量组的有效率分别为42.9％(12/28),71.4％(20/28),92.9％(26/28),其中足剂量组有效率明显高于对照组和常规剂量组(x2=16.047、6.788,均P＜0.01),常规剂量组的有效率与对照组比较亦明显升高(x2=4.667,P＜0.01).结论 足剂量、足频率的盐酸氨溴索联合复方异丙托溴铵雾化吸入治疗老年人难治性肺炎有较好的临床疗效.
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