Clinical research of ulinastatin combined with ambroxol hydrochloride in the treatment of acute respiratory distress syndrome complicated with ventilator-associated pneumonia / 中国基层医药

ABSTRACT

Objective To study the clinical efficacy of ulinastatin combined with ambroxol hydrochloride in the treatment of acute respiratory distress syndrome (ARDS) complicated with ventilator-associated pneumonia (VAP).Methods One hundred and ten cases of ARDS complicated with VAP were randomly divided into the study group (55 cases) and the control group (55 cases) according to the different treatment method.The two groups accepted symptomatic anti-infective treatment,and the control group was treated with 300mg of ambroxol twice daily,the study group were intravenously infused 200 000U ulinastatin on the basis of the control group,two groups of patients were treated for 1 week.The ventilation indicators,pathogen clearance rate,off-time rate,mechanical ventilation time,respiratory rate,APACHE score,lung injury score and adverse reactions during the treatment were compared between the two groups.Results After treatment,PaO2,PaO2/FiO2,CL,RAW and PIP in the study group were (97.83 ± 12.01)mmHg,(364.25 ±35.77)mmHg,(88.93 ±9.44)mL/cmH2O,(31.45 ±4.87)cmHH2O · L-1 · s-1,(21.43 ± 5.75)cmH2O,respectively,which in the control groupwere (83.25 ± 10.13)mmHg,(238.55 ± 34.29) mmHg,(62.77 ± 8.54) mL/cmH2 O,(37.97 ± 6.54) cmH2 O · L-1 · s-1,(29.12 ± 5.43) cnH2 O,respectively.The P.aO2,PaO2/FiO2,CL in the study group were significantly higher than those in the control group,the RAW,PIP in the study group were significantly lower than those in the control group,the differences were statistically significant (t =6.88,18.81,5.93,7.21,15.42,all P ＜ 0.05).The clearance rate of both Gram-positive lacteria (90.00％)and Gram-negative bacteria (92.00％) in the study group were significantly higher than those in the control group (66.67％ and 70.21％) (x2 =4.81,8.84;P =0.03,0.00).The mean mechanical ventilation time in the study group [(7.15 ± 2.43) days] was significantly shorter than that in the control group [(12.85 ± 3.12) days] (t =10.69,P ＜ 0.05).The respiratory rate,APACHE score and lung injury scores of the two groups were significantly lower than those before treatment (P ＜ 0.05).The respiratory rate,APACHE scores and lung injury scores of the study group [(18.94 ± 6.99) times/min,(12.53 ± 3.14) points,(1.31 ± 0.15) points] were significantly lower than those of the control group [(25.87 ± 6.12) times/min,(16.53 ± 4.42) points,(1.65 ± 0.32) points],the differences were statistically significant (t =5.53,5.47,7.14;P =0.00,0.00,0.00).The off-line success rate and mortality between the two groups had no statistically significant differences (all P ＞ 0.05).Conclusion Ulinastatin combined with ambroxol hydrochloride can significantly improve the respiratory function of ARDS patients complicated with VAP,significantly shorten the duration of mechanical ventilation,improve respiratory function,reduce lung injury and improve pathogens clearance rate,but with no significant impact on mortality.