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目的探讨氨溴索联合振动排痰机在呼吸机相关性肺炎(VAP)患者中的应用效果,为提高临床诊治水平提供参考。方法 2010年6月-2014年10月240例机械通气VAP患者随机分为A、B、C组,每组各80例,所有患者均进行有创呼吸机辅助机械通气,并每天进行脱机试验判断;A组患者仅实施基础治疗,B组患者在基础治疗的基础上采用氨溴索静脉滴注,C组在B组的基础治疗上加用排痰机振动排痰;每天观察并记录患者的体温、心率、呼吸频率等,定期进行血常规、动脉血气和胸片检查,统计急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ),对比3组患者的疗效;采用SPSS 17.0软件进行统计分析。结果治疗前3组患者两两之间的APACHEⅡ评分、氧合指数、心率、呼吸频率的差异均无统计学意义;治疗后各组患者的APACHEⅡ评分、氧合指数、心率、呼吸频率均得以显著改善,差异均有统计学意义(P<0.05),B组和C组患者显著优于A组(P<0.05),C组患者显著优于B组(P<0.05);C组患者的治疗有效率为96.3%,显著高于B组的82.5%和A组的72.5%,差异有统计学意义(P<0.05);无严重并发症和死亡病例发生。结论氨溴索联合振动排痰机在VAP患者中治疗效果优于单纯氨溴索治疗。
Objective To investigate the effect of ambroxol combined with vibration and sputum aspirator in patients with ventilator-associated pneumonia (VAP) and provide references for improving the level of clinical diagnosis and treatment. Methods From June 2010 to October 2014, 240 patients with VAP undergoing mechanical ventilation were randomly divided into A, B and C groups, 80 patients in each group. All patients underwent invasive ventilator-assisted mechanical ventilation and daily off-line test The patients in group A received intravenous infusion of ambroxol only on the basis of basic treatment while the patients in group C received sputum aspiration and sputum on the basis of basic treatment in group B. The patients were observed and recorded daily The blood pressure, arterial blood gas and chest X-ray examination were performed on a regular basis. The acute physiology and chronic health status score Ⅱ (APACHEⅡ) were compared. The curative effect was compared between the three groups. The data were analyzed by SPSS 17.0 software. Results There was no significant difference in APACHEⅡ score, oxygenation index, heart rate and respiratory rate between the two groups before treatment. APACHEⅡ score, oxygenation index, heart rate and respiratory rate were all significant in all groups after treatment (P <0.05). The patients in group B and group C were significantly better than those in group A (P <0.05), and those in group C were significantly better than those in group B (P <0.05). The treatment of group C The effective rate was 96.3%, significantly higher than 82.5% in group B and 72.5% in group A, the difference was statistically significant (P <0.05); no serious complications and deaths occurred. Conclusion Ambroxol combined with vibration sputum in VAP patients is superior to the treatment of ambroxol alone.