雾化吸入不同剂量盐酸乙酰半胱氨酸溶液联合阿米卡星治疗呼吸机相关性肺炎的效果及对患者血气指标和炎症因子的影响

摘要 目的：探讨雾化吸入不同剂量盐酸乙酰半胱氨酸溶液联合阿米卡星治疗呼吸机相关性肺炎的效果及对患者血气指标和炎症因子的影响。方法：选取我院2020年1月到2023年1月收治的98例呼吸机相关性肺炎患者作为研究对象，应用随机数字表法将其分为对照组（n=38）、观察A组（n=30）与观察B组（n=30）。对照组采用阿米卡星注射液静脉滴注，观察组A组在对照组基础上采取3 mL盐酸乙酰半胱氨酸溶液雾化吸入，观察B组在对照组基础上采取6 mL盐酸乙酰半胱氨酸溶液雾化吸入，对比三组患者临床疗效、血气指标、炎症因子水平以及不良反应发生率。结果：观察B组和观察A组治疗总有效率明显对照组，且观察B组治疗总有效率明显高于观察A组（P＜0.05）；三组患者治疗前动脉血二氧化碳分压（PaCO₂）、动脉血氧分压（PaO₂）水平对比无明显差异（P＞0.05），治疗后三组患者PaO₂均升高，且观察B组和观察A组明显高于对照组，观察B组高于观察A组（P＜0.05），PaCO₂均降低且观察B组和观察A组明显低于对照组，观察B组低于观察A组（P＜0.05）；三组患者治疗前白细胞计数（WBC）、中性粒细胞百分比（GRA）、降钙素原（PCT）、C反应蛋白（CRP）、血沉（ESR）表达水平对比无明显差异（P＞0.05），治疗后三组患者WBC、GRA、PCT、CRP、ESR表达水平均降低，且观察B组和观察A组明显低于对照组，观察B组高于观察A组（P＜0.05）；三组患者不良反应发生率对比无明显差异（P＞0.05）。结论：对呼吸机相关性肺炎患者采用雾化吸入盐酸乙酰半胱氨酸溶液联合阿米卡星治疗效果显著，但采取6 mL剂量能够进一步改善患者呼吸功能，降低患者机体炎症因子表达水平，且安全性较高。

Effect of Atomization Inhalation of Different Doses of Acetylcysteine Hydrochloride Solution Combined with Amikacin in the Treatment of Ventilator-associated Pneumonia and Its Influence on Blood Gas Index and Inflammatory Factors

ABSTRACT Objective: To explore the effect of atomization inhalation of different doses of acetylcysteine hydrochloride solution combined with amikacin in the treatment of ventilator-associated pneumonia and the influence on blood gas index and inflammatory factors of patients. Methods: 98 patients with ventilator-associated pneumonia admitted to our hospital from January 2020 to January 2023 were selected as study subjects. They were divided into control group (n=38), observation group A (n=30) and observation group B (n=30) by random number table method. The control group was treated with intravenous infusion of amikacin injection. The observation group A was treated with aerosol inhalation of 3 ml acetylcysteine hydrochloride solution on the basis of the control group. The observation group B was treated with aerosol inhalation of 6 ml acetylcysteine hydrochloride solution on the basis of the control group. The clinical efficacy, blood gas index, inflammatory factor level and adverse reaction rate of the three groups were compared. Results: The total effective rate of observation group B and observation group A was higher than that of observation group A (P<0.05); There was no difference in the levels of arterial blood partial pressure of oxygen (PaO₂) and arterial blood partial pressure of oxygen (PaO₂) among the three groups Pretherapy (P>0.05). Post-treatment, the levels of PaO₂ in the three groups increased, and the levels of PaO2 in group B and group A were higher than those in the control group, while those in group B were higher than those in group A(P<0.05), PaCO₂ was lower in both observation group B and observation group A than in control group, and observation group B was lower than observation group A (P<0.05); There was no significant difference in the expression of white blood cell count (WBC), percentage of neutrophils (GRA), procalcitonin (PCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) among the three groups Pretherapy (P>0.05). The expression of WBC, GRA, PCT, CRP and ESR in the three groups decreased Post-treatment, And observation group B and observation group A were lower than the control group, and observation group B was higher than observation group A (P<0.05); There was no difference in the incidence of adverse reactions among the three groups(P>0.05). Conclusion: The efficacy of aerosol inhalation of acetylcysteine hydrochloride solution combined with amikacin in the treatment of patients with ventilator-associated pneumonia is significant, but the dose of 6ml can further improve the respiratory function of the patients, reduce the expression level of inflammatory factors in the patients, and the safety is high.