支气管镜肺泡灌洗氨溴索联合参芪扶正注射液对老年重症肺炎合并呼吸衰竭患者氧化应激状态、血管内皮功能及肺泡氧合功能的影响

摘要

Objective It is to observe the effect of bronchoalveolar lavage with ambroxol combined with Shenqifuzheng in -jection on the oxidative stress status,endothelial function and alveolar oxygenation of the elderly with severe pneumonia(SP) with respiratory failure(RF).Methods 100 cases of elder patients with SP and RF were randomly divided into observation group(50 cases)and control group(50 cases),both groups were given routine treatment,additionally the control group was given bronchoalveolar lavage with ambroxol while the observation group were given bronchoalveolar lavage with ambroxol +Shenqifuzheng injection by intravenous drip.Both groups were treated for 14 days.The indexes of oxidative stress status,en-dothelial function and alveolar oxygenation function were observed before treatment,at d3,d7,d14 in both groups,the clini-cal outcomes were observed too.Results After treatment for 3,7,14 days,the levels of serum superoxide dismutase(SOD), glutathione peroxidase(GSH-Px), nitric oxide(NO), and the arterial blood gas analysis indexes such as p(O2)and Sa (O2)were significantly increased(P<0.05),while the levels of serum malondialdehyde(MDA),8-different prostaglandins F2 alpha(8-iso-PGF2 alpha),endothelin-1(ET-1)and arterial blood gas analysis indexes such as lactic acid(Lac), p (CO2)were significantly increased in both groups(P<0.05),and the improvements of all the above indicators in the obser-vation group were better than those of control group(P<0.05).The mechanical ventilation time, inflammation disappear time in chest CT,length of hospital stay were shorter and the intubation rate,occurrence rates of ventilator associated lung in-jury(VILI)and ventilator associated pneumonia(VAP)and fatality rate were lower in the observation group than those in the control group(P<0.05).Conclusion Bronchoalveolar lavage with ambroxol combined with Shenqifuzheng injection can sig -nificantly improve oxidative stress status and endothelial function,and thus improve alveoli oxygenation function,promote re-covery and reduce the incidence of poor clinical outcomes in the elderly with SP and RF.%目的 观察支气管镜肺泡灌洗氨溴索联合参芪扶正注射液对重症肺炎(SP)合并呼吸衰竭(RF)氧化应激状态、血管内皮功能及肺泡氧合功能的影响.方法 将100例老年重症肺炎合并呼吸衰竭患者随机分为观察组50例和对照组50例,2组均接受常规治疗,对照组在常规治疗基础上给予支气管镜肺泡灌洗氨溴索治疗,观察组在对照组治疗基础上加用参芪扶正注射液治疗,2组均连续治疗14 d.观察2组治疗前及治疗第3,7,14天氧化应激状态、血管内皮功能及肺泡氧合功能相关指标,并观察2组临床结局.结果 2组血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)、一氧化氮(NO)水平均显著升高(P均<0.05),而丙二醛(MDA)、8-异前列腺素F2α(8-iso-PGF2α)、内皮素-1(ET-1)水平均显著降低(P均<0.05),观察组上述指标的改善情况均优于对照组(P均<0.05);2组治疗第3,7,14天动脉血气分析指标乳酸(Lac)、二氧化碳分压[p(CO2)]均显著降低(P均<0.05),而血氧分压[p(O2)]、血氧饱和度[Sa(O2)]均显著增高(P均<0.05),观察组上述指标改善情况均优于对照组(P均<0.05);观察组机械通气时间、胸部CT中炎症消失时间、住院时间均短于对照组(P均<0.05),再插管率、呼吸机相关性肺损伤(VILI)、呼吸机相关性肺炎(VAP)及病死率均低于对照组(P均<0.05).结论 支气管镜肺泡灌洗氨溴索联合参芪扶正注射液能够显著改善老年重症肺炎合并呼吸衰竭患者的氧化应激状态及血管内皮功能,从而提高患者肺泡氧合功能,促进病情恢复并降低临床不良结局发生率.