| 摘要: |
| 目的探讨老年急性呼吸窘迫综合征（ARDS）患者经硝酸甘油联合亚低温治疗对其肺毛细血管通透性的影响及短期疗效。方法将73例老年ARDS患者按随机数字表法分为观察组37例与对照组36例。对照组患者接受常规对症处理以及原发病治疗，观察组患者在此基础上给予硝酸甘油联合全身降温（亚低温）的方式治疗。分别记录两组患者不同时段的氧合指数、血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）以及计算急性生理学和慢性健康状况评分（APACHEⅡ）。对比支气管肺泡灌洗液中TNF-α、肺泡表面活性蛋白A（SP-A）、血管内皮生长因子（VEGF）水平、循环内皮细胞数（CEC）以及7d、28d病死率。结果治疗后，两组患者APACHEⅡ评分均有所升高（均P＜0.05），而对照组氧合指数较治疗前降低（P＜0.05）。组间比较显示，观察组治疗后第24、48、72h的APACHEⅡ评分均低于对照组（均P＜0.05），氧合指数均高于对照组（均P＜0.05）。治疗后第72h观察组EVLWI、PVPI、VEGF、CEC和TNF-α水平较对照组低，SP-A水平则较对照组高（P＜0.05）。且观察组机械通气时间显著短于对照组（P＜0.01），7d、28d病死率高于对照组（P＜0.05）。结论老年ARDS患者接受硝酸甘油联合亚低温治疗可改善患者早期肺氧合功能，降低肺血管通透性，减少炎症因子释放，缩短患者机械通气时间，降低病死率。 |
| 关键词: 急性呼吸窘迫综合征 老年 亚低温 肺血管 |
| DOI：10.12056/j.issn.1006-2785.2017.40.1.2017-1470 |
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| Efficacy of nitroglycerin combined with mild hypothermia intervention for elderly patients with acute respiratory distress syndrome |
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Ningbo Seventh Municipal hospital
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| Abstract: |
| Objective To assess the efficacy of nitroglycerin combined with mild hypothermia for elderly patients with acute respiratory distress syndrome (ARDS). Methods Seventy three elderly patients with ARDS admitted in ICU from February 2014 to October 2016 were randomly assigned to 2 groups; 36 patients received conventional symptomatic treatment (control group) and 37 patients were treated with nitroglycerin combined with mild hypothermia intervention in addition to conventional therapy (intervention group). The PaO2/FaO2, EVLWI, PVPI, APACHE II score were documented; serum TNF-α, SP-A, VEGF and circulating epithelial cells (CEC) were measured at 24h, 48h, 72h after treatment; and the survival at 7d and 28d after treatment
was recorded in two groups. Results After treatment, APACHE II scores in both groups were increased (P＜0.05), while the oxygenation indexes in control group decreased compared with those before treatment (P＜0.05). The APACHE II scores at 24h, 48h and 72h after treatment in intervention group were lower; and the oxygenation indexes were higher than those in the control group (P＜0.05). The EVLWI, PVPI, VEGF, CEC and TNF-α levels of intervention group were lower; and the level of SP-A was higher than those in the control group(P＜0.05). Mechanical ventilation time in the intervention group was significantly shorter than that in control group(P＜0.01); the 7d, 28d survival rate was higher(P＜0.05). Conclusion Elderly patients with acute respiratory distress syndrome receiving nitroglycerin combined with hypothermia intervention can improve pulmonary oxygenation and
reduce pulmonary vascular permeability and reduce the release of inflammatory factors, shorten the time of mechanical ventilation patients, and decrease the mortality rate. |
| Key words: Acute respiratory distress syndrome Elderly Mild hypothermia Pulmonary vascular |
