大剂量氨溴索对老年慢性阻塞性肺疾病合并呼吸衰竭患者C反应蛋白、氧化应激反应、血气及呼吸功能的影响

摘要

Objective To explore the influence of large dose of ambroxol hydrochloride on C-reactive protein(CRP),oxidative stress,blood gas,and respiratory function in elderly patients with chronic obstructive pulmonary disease(COPD) complicating respiratory failure.Methods 92 elderly patients with COPD complicating with respiratory failure were randomly divided into an observation group(n=46) and a control group(n=46).All the patients were treated with mechanical ventilation and conventional therapy;the observation group were given a large dose of ambroxol hydrochloride and the control group placebo.The CRP,MDA,SOD,PaO2,SaO2,OI,Lac,PH,MVV,FEV1,MMF,FVC,Qs/Qt,PA-aDO2,PIMAX,PEMAX,mechanical ventilation time,VAP incidence,and mortality rate were compared between the two groups before and 3,5 days after the treatment.Results There were no statistical differences in CRP,MDA,SOD,PaO2,SaO2,OI,Lac,PH,MVV,FEV1,MMF,FVC,Qs/Qt,PA-aDO2,PIMAX,and PEMAX between the two groups (P＞0.05).The CRP,MDA,Lac,Qs/Qt,PA-aDO2 were significantly lower and the SOD,PaO2,SaO2,OI,PH,MVV,FEV1,MMF,FVC,PIMAX,and PEMAX significantly higher in the observation group than in the control group 3 and 5 days after the treatment (P＜0.05).The incidence of VAP was significantly lower in the observation group than in the control group (P＜0.05).There no statistical difference in mortality between the two groups (P ＞ 0.05).Conclusions Large dose of ambroxol hydrochloride in the treatment of the elderly patients with COPD complicating respiratory failure is safe and effective and can effectively reduce the CRP level and the incidence of VAP and improve the oxidative stress response,blood gas,and respiratory function,reduce incidence,so it is worth being generalized.%目的 探讨大剂量氨溴索对老年慢性阻塞性肺疾病合并呼吸衰竭患者C反应蛋白(CRP)、氧化应激反应、血气及呼吸功能的影响.方法 92例慢性阻塞性肺疾病合并呼吸衰竭患者随机分为观察组与对照组,每组46例.所有患者均给予呼吸机辅助通气及常规治疗,观察组在上述治疗基础上加用大剂量盐酸氨溴索治疗,对照组则在常规治疗基础上加用安慰剂治疗,两组患者治疗前、治疗第3d、第5d的CRP、丙二醛(MDA)、超氧化物歧化酶(SOD)、动脉血氧分压(PaO2)、动脉血氧饱和度(SaO2)、氧合指数(OI)、血乳酸(Lac)、酸碱度(PH)、肺通气功能MVV、FEV1、MMF、FVC、Qs/Qt、PA-aDO2、PIMAX、PEMAX、机械通气时间、呼吸机相关性肺炎(VAP)发生率、患者病死率比较.结果 治疗前两组CRP、MDA、SOD、PaO2、SaO2、OI、Lac、PH、MVV、FEVt、MMF、FVC、Qs/Qt、PA-aDO2、PIMAX、PEMAX比较,差异均无统计学意义(P＞0.05),治疗后第3d、5d观察组CRP、MDA、Lac、Qs/Qt、PA-aDO2显著低于对照组,SOD、PaO2、SaO2、OI、PH、MVV、FEVl、MMF、FVC、PIMAX、PEMAX显著高于对照组,差异有统计学意义(P＜0.05);观察组VAP发生率显著低于对照组,机械通气时间显著短于对照组,差异有统计学意义(P＜0.05);两组患者病死率比较,差异无统计学意义(均P＞ 0.05).结论 大剂量氨溴索可有效降低老年COPD合并呼吸衰竭患者CRP水平,改善患者氧化应激反应与血气,提高患者呼吸功能,降低VAP发生率,安全高效,值得推广.