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细辛脑注射液联合多索茶碱对有创机械通气患者呼吸力学的影响

来源:用户上传      作者:何泰良 刘红梅 欧阳桂兰 郑爱华

  [摘要] 目的 研究静脉注射细辛脑注射液联合多索茶碱对有创机械通气患者呼吸力学等指标的影响。 方法 将2020年6月至2021年8月湖南少中医院重症医学科接受有创机械通气的60例呼吸衰竭患者随机分为两组,对照组30例使用单独多索茶碱静注治疗,治疗组30例使用细辛脑联合多索茶碱静脉注射治疗,分别观察治疗前和治疗0.5、1、3、6 h和呼吸力学指标(气道峰压、气道平台压、吸气阻力、动态肺顺应性),监测治疗前、治疗后1、3 h血气氧合指数水平。 结果 治疗组给药后各时间点气道峰压、吸气阻力明显低于对照组(P<0.05),动态肺顺应性、氧合指数明显高于对照组(P<0.05)。 结论 呼吸衰竭的患者应用细辛脑注射液联合多索茶碱治疗优于多索茶碱单药治疗,更能改善患者的呼吸功能,减少气道阻力和气道内压力,改善动态肺顺应性,提升氧合指数,提升肺通气和换气效率。
  [关键词] 细辛脑注射液;多索茶碱;呼吸衰竭;机械通气;呼吸力学
  [中图分类号] R318.1 [文献标识码] B [文章号] 1673-9701(2022)13-0013-04
  [Abstract] Objective To investigate the effect of intravenous asarone injection combined with doxofylline on respiratory mechanics and other indexes in patients undergoing invasive mechanical ventilation. Methods A total of 60 patients with respiratory failure who received invasive mechanical ventilation in the Department of Critical Care Medicine in the Second Affiliated Hospital of Hunan University of Chinese Medicine from June 2020 to August 2021 were randomly divided into two groups. The control group (n=30) were treated with doxofylline infusion alone, and the treatment group (n=30) were treated with asarone combined with doxofylline infusion. The respiratory mechanical indexes (peak airway pressure, airway plateau pressure, inspiratory resistance, and dynamic lung compliance) were observed before treatment, 0.5, 1, 3, 6 h after treatment.The blood oxygenation index levels were monitored before treatment, 1,3 h after treatment. Results After treatment, the peak airway pressure and inspiratory resistance in the treatment group were significantly lower than those in the control group(P<0.05), and the dynamic lung compliance and oxygenation index in the treatment group were significantly higher than those in the control group (P<0.05). Conclusion Asarone injection combined with doxofylline is superior to doxofylline monotherapy in patients with respiratory failure, which improves respiratory function, reduces airway resistance and intra airway pressure, improves dynamic lung compliance, elevates oxygenation index, and increases lung ventilation and ventilatory efficiency.
  [Key words] Asarone injection; Doxofylline; Respiratory failure; Mechanical ventilation; Respiratory mechanics
  呼吸衰竭是指各种呼吸系统及呼吸系统以外的疾病,导致肺通气或换气功能障碍,以至于无法维持有效气体交换,引起缺氧或二氧化碳潴留,从而表现出胸闷、气促、呼吸困难,甚至造成心、脑、肾等器官受损的一类综合征。其中急性呼吸衰竭更是致命的,短时间内能够引起机体严重缺氧及酸中毒,导致呼吸心跳骤停甚至死亡。而机械通气作为对症处理各类急慢性呼吸衰竭的一种有效手段,通过口鼻面罩或建立人工气道连接呼吸机,使用正压辅助通气替代一部分肺功能,实现呼吸支持[1],为改善导致呼吸衰竭的病因治疗争取时间。在持续机械通气过程中,监测分析各类呼吸力学指标有助于了解患者目前病情状态,指导后期参数设定和药物治疗,缩短患者机械通气时间、ICU住院时间,减少呼吸机相关性肺损伤的发生率,提升安全性,同时检验综合疗效[2-3]。因此本研究对实施有创机械通气的呼吸衰竭患者应用细辛脑注射液,通过监测气道峰压(peak inspiratory pressure,PIP)、气道平台压(plateau pressure,Pplat)、吸气阻力(inhalation resistance,Ri)、动态肺顺应性(dynamic lung compliance,Cdyn)等呼吸力学指标及血气氧合指数(oxygenation index,OI),观察并对比细辛脑联合多索茶碱静脉注射与单纯静注多索茶碱两组患者的各项指标变化情况,现报道如下。

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