有创通气与大剂量沐舒坦治疗脑卒中后重症肺炎的疗效及对脑神经功能的影响

目的:探究有创通气与大剂量沐舒坦治疗脑卒中后重症肺炎的疗效及对脑神经功能的影响。方法:于2013年6月~2016年2月期间,选择广州医科大学附属第四医院呼吸重症医学科收治老年脑卒中合并重症肺炎患者76例为研究对象,采用随机数字法将所有研究对象分为观察组(40例)和对照组(36例);两组患者均给予常规治疗及有创通气,观察组患者给予大剂量沐舒坦治疗,对照组患者给予小剂量剂量沐舒坦治疗;观察并比较两组患者神经功能恢复情况、治疗情况、肺炎严重程度、记录氧分压(PaO_2)、二氧化碳分压(PaCO_2)、C反应蛋白(CRP)水平。结果:两组患者治疗前PaO_2、PaCO_2、肺炎严重程度评分(CURB-65)及CRP水平无差异(P0.05);治疗后两组患者PaCO_2、CURB-65及CRP水平均显著降低,PaO_2水平显著升高;且观察组患者PaCO_2、CURB-65及CRP水平低于对照组,PaO_2水平显著高于对照组(P0.05);治疗前两组患者脑卒中神经功能损伤程度评分(NFDS)及美国国立卫生院脑卒中评分(NIHSS)无差异(P0.05);治疗后两组患者NFDS及NIHSS评分均降低(P0.05),两组间NFDS及NIHSS评分无差异(P0.05);治疗后观察组患者机械通气时间、抗生素使用时间、症状缓解时间及ICU住院时间均低于对照组(P0.05)。结论:有创通气联合大剂量沐舒坦治疗脑卒中后重症肺炎疗效确切,能够提高患者脑神经功能,值得在临床应用推广。

The Curative Effect of Invasive Ventilation with Large Dose of Mucosolvan in Treatment of Severe Pneumonia after Stroke and its Effect of Cerebral Nerve Function

ABSTRACT Objective: To explore the curative effect of invasive ventilation with large dose of Mucosolvan in treatment of severe pneumonia after stroke and its effect of cerebral nerve function. Methods: 76 cases of elderly stroke patients with severe pneumonia were selected from the Fourth Affiliated Hospital of Guangzhou Medical University from June 2013 to February,which were divided into observation group (40 cases) and control group (36 cases); Patients in both groups were given anti-infection treatment and invasive ventilation; observation group received high dose mucosolvan treatment and the control group received low dose mucosolvan. To observe and compare the two groups of patients with neurological function recovery situation, treatment situation, pneumonia severity, record the levels of PaO₂, PaCO₂, CRP. Results: The levels of PaCO₂, PaO₂, pneumonia severity score (CURB-65) and CRP were not different between two groups of patients(P>0.05); The levels of PaCO₂, CURB-65 and CRP in two groups of patients were significantly lower and the levels of PaO₂ were significant increased; and the level of PaCO₂, CURB-65 and CRP in observation group were significant lower than that of the control group, the levels of PaO₂ was significantly higher than that of control group (P<0.05) after treatment; The scores of NFDS and NIHSS in both groups had no difference before treatment(P>0.05); The scores of NFDS and NIHSS were reduced (P<0.05),and there were no difference on NFDS and NIHSS score between two groups after treatment(P>0.05); The time of mechanical ventilation, antibiotic use,symptom relief and ICU residence in observation group were lower than those in control group (P<0.05). Conclusion: The curative effect of invasive ventilation combined with large dose of mucosolvan in treatment of severe pneumonia after stroke is exact, which can improve the cranial nerve function, worthy of clinical popularization and application.