机械通气联合东莨菪碱治疗急性呼吸窘迫综合征临床观察.docVIP

机械通气联合东莨菪碱治疗急性呼吸窘迫综合征临床观察 　　作者：沙国强,龚兆荣,肖泽勇,江勇　　作者单位：广东省广州医学院附属深圳沙井医院 　　【摘要】 目的：探讨机械通气联合东莨菪碱治疗急性呼吸窘迫综合征的临床疗效。方法：将符合标准的83例急性呼吸窘迫综合征患者随机分成观察组(49例)和对照组(34例)，对照组采用以机械通气为主的常规综合治疗，观察组在常规综合治疗基础上加用东莨菪碱治疗。结果：治疗48 h后观察组的PaO2、氧合指数 (PaO2/FiO2 ) 明显高于对照组 (P0.05)，而 PaCO2在两组间差异无统计学意义(P0.05);治疗10d后，观察组显效率为46.94%，总有效率为95.92%均显著高于对照组(P0.05);观察组并发症发生率为14.29%，显著低于对照组(P0.05)。结论：东莨菪碱联合机械通气对急性呼吸窘迫综合征的临床疗效确切，值得临床推广应用。 　　【关键词】 急性呼吸窘迫综合征;机械通气;东莨菪碱 　　[ABSTRACT] Objective： To investgate clinical efficacy of scopolamine combined with mechanical ventilation on patients with acute respiratory distress syndrome. Methods：A total of 83 patients with acute respiratory distress syndrome were randomly divided into observed group (49 cases) and control group (34 cases). Patients in control group only received the comprehensive treatment mainly composed by mechanical ventilation， while others in control group received scopolamine based on conventional treatment. Curative effect was observed and compared between two groups. Results：After treatment for 48 hours， PaO2 and PaO2/FiO2 in the observed group were significantly higher than those in the control group (P 0.05); the effectiveness was 46.94% and total efficiency was 95.92% in observed group， significantly higher than those in control group( P0.05 ); the incidence of complication was 14.92% in observed group， significantly lower than that in control group (P0.05). Conclusions：Scopolamine and mechanical ventilation is an effective method for treatment of acute respiratory distress syndrome and it is worthy clinical application. 　　[KEY WORDS] Acute respiratory distress syndrome; Mechanical ventilation; Scopolamine 　　急性呼吸窘迫综合征(acute respiratory distress syndrome， ARDS)是指肺内、外严重疾病导致以肺毛细血管弥漫性损伤、通透性增强为基础，以肺水肿、透明膜形成和肺不张为主要病理变化，以进行性呼吸窘迫和难治性低氧血症为临床特征的急性呼吸衰竭综合征[1]。该类疾病是临床上常见的危重症之一，起病急骤，发展迅猛，预后极差，死亡率高达50%以上[2]。目前机械通气仍然是纠正低氧血症、提高或维持全身氧输送的重要手段，但结果表明，即使单纯采用合理的机械通气治疗，患者的病死率仍可达40%～70%[5]。有研究表明东莨菪碱能抑制腺体分泌，减轻肺泡的渗出，急性呼吸窘迫综合征具有明显的疗效[6]。因此，本研究尝试性地应用东莨菪碱联