目的 觀察大劑量鹽酸氨溴索對肝移植術后ALI的治療效果,初步探討其機制。方法 選擇肝移植術后ALI患者30例,隨機分為試驗組和對照組,每組15例。兩組患者在常規抗感染、抗排斥以及營養支持等綜合治療的基礎上,試驗組每天給予鹽酸氨溴索15 mg/kg持續靜脈滴注,對照組每天給予等容積單純生理鹽水滴注,連續7 d。比較兩組治療前,治療后1、3和7 d的動脈血氣、血清炎癥介質(IL-1、IL-10和TNF-α)水平,以及住ICU時間的差異,統計患者1年內死亡率。結果 兩組患者的PaO2和PaO2/FiO2水平治療后均明顯改善,試驗組PaO2和PaO2/FiO2在治療后1、3和7 d明顯高于對照組(P均 lt;0.05)。兩組患者治療前的炎癥介質水平無顯著差異(P均 gt;0.05),試驗組患者IL-1及TNF-α水平在治療后1 d顯著低于對照組[(0.25±0.10)μg/L和(50.46±5.08)μg/L比(0.32±0.08)μg/L和(61.20±6.15)μg/L,P均 lt;0.05];IL-10水平在治療后1 d較對照組顯著升高[(11.92±1.01)μg/L比(10.98±1.42)μg/L,P lt;0.05),3 d和7 d兩組炎癥介質水平無顯著差異(P均 gt;0.05)。試驗組患者的ICU住院時間顯著短于對照組[(8.2±5.6)d比(11.4±6.5)d,P lt;0.05]。試驗組和對照組分別死亡2例和3例,差異無統計學意義(P gt;0.05)。結論 大劑量鹽酸氨溴索能促進肝移植術后ALI患者的氧合狀況的改善,縮短住ICU時間;同時可能通過降低促炎介質IL-1和TNF-α的水平,增加抗炎因子IL-10水平,從而有助于減輕肺部炎癥反應。
引用本文:
雷聯會,韋中余,俞森洋,王瑜貴,程芮,楊洋,臧運金. 大劑量鹽酸氨溴索治療肝移植術后急性肺損傷的臨床觀察及其對炎癥介質的影響. 中國呼吸與危重監護雜志, 2008, 08(5): 334-337. doi:
復制
1. |
陳剛,葉啟發,劉慎微,等.肝移植術后早期并發成人呼吸窘迫綜合征的原因及其防治.中華器官移植雜志,2000,21:123.
|
2. |
Romanini BM,Sandri MG,Tosi M,et al.Ambroxol for prophylaxis and treatment of broncho-pulmonary complications after chest surgery.Int J Clin Res,1996,2:123-127.
|
3. |
Laoag-Fernandez JB,Fernandez AM,Maruo T.Antenatal use of ambroxol for the prevention of infant respiratory distress syndrome.J Obstet Gynaecol Res,2000,26:307-312.
|
4. |
張清,袁世熒,姚尚龍.大劑量沐舒坦對急性呼吸窘迫綜合征患者抗氧化能力的影響.臨床麻醉學雜志,2004,3:135-137.
|
5. |
吳紅濤,麻曉林,蔣耀光.沐舒坦針劑治療兔創傷性急性肺損傷的實驗研究.創傷外科雜志,2005,1:57-60.
|
6. |
白春學,孫波,主編.急性呼吸窘迫綜合征.上海:復旦大學出版社,2005,56-57.
|
7. |
鄭樹森,主編.肝臟移植.北京:人民衛生出版社,2001,339-345.
|
8. |
陳曉峰,丁嘉安,高文,等.開胸術后發生急性呼吸窘迫綜合征的病因探討及治療.中華外科學雜志,2003,41:906-908.
|
9. |
Quinlan GJ,Mumby S,Lamb NJ,et al.Acute respiratory distress syndrome secondary to cardiopulmonary bypass:do compromised plasma iron-binding anti-oxidant protection and thiol levels influence outcome?Crit Care Med,2000,28:2271-2276.
|
10. |
Stettner S,Ledwozy WA.The effect of Ambroxol on bleomycin-induced changes in phospholipid composition of rat lung surfactant.Acta Physiol Hung,1995,83:181-187.
|
11. |
張波,劉又寧.溴環己胺醇對通氣機導致肺損傷保護作用的研究.中華醫學雜志,2000,80:51-53.
|
12. |
Wesierska-Gadek J,Goetz AE.Role of PARP on iNOS pathway during endotoxin-induced acute lung injury.Intensive Care Med,2004,30:1421-1431.
|
13. |
Schott R,Chaouat A,Launoy A,et al.Improvement of pulmonary hypertension after liver transplantation.Chest,1999,115:1748-1749.
|
14. |
Slutsky AS.Acute lung injury(ALI) and the acute respiratory distress syndrome(ARDS).Transfusion Alternatives in Transfusion Medicine,2004,6(suppl):45.
|
15. |
Kopko PM,Marshall CS,Mackenzie MR,et al.Transfusion-related acute lung injury,report of aclinical look-back investigation,JAMA,2002,287:1968-1971.
|
16. |
Markart P,Schmidt R,Ruppert C,et al.Ischemic and endotoxin pre-conditioning reduce lung reperfusion injury-induced surfactant alterations.J Heart Lung Transplant, 2005,24:1680-1689.
|
17. |
顧小萍,徐福濤,仇毓東,等.原位肝移植大鼠供肝冷缺血時間對受體肺損傷的影響.國際麻醉學與復蘇雜志,2006,1:22-24.
|
18. |
Barsness KA,Bensard DD,Partrick DA,et al.IL-1beta induces an exaggerated pro-and anti-inflammatory response in peritoneal macrophages of children compared with adults.Pediatr Surg Int,2004,20:238-242.
|
19. |
Farivar AS,Krishnadasan B,Naidu BV,et al.Endogenous interleukin-4 and interleukin-10 regulate experimental lung ischemia reperfusion injury.Ann Thorac Surg,2003,76:253-259.
|
20. |
劉昌,宋宇龍,劉峰,等.大鼠供肝冷缺血時間與肝移植術后受者肺損傷的關系.中華器官移植雜志,2006,3:138-141.
|
- 1. 陳剛,葉啟發,劉慎微,等.肝移植術后早期并發成人呼吸窘迫綜合征的原因及其防治.中華器官移植雜志,2000,21:123.
- 2. Romanini BM,Sandri MG,Tosi M,et al.Ambroxol for prophylaxis and treatment of broncho-pulmonary complications after chest surgery.Int J Clin Res,1996,2:123-127.
- 3. Laoag-Fernandez JB,Fernandez AM,Maruo T.Antenatal use of ambroxol for the prevention of infant respiratory distress syndrome.J Obstet Gynaecol Res,2000,26:307-312.
- 4. 張清,袁世熒,姚尚龍.大劑量沐舒坦對急性呼吸窘迫綜合征患者抗氧化能力的影響.臨床麻醉學雜志,2004,3:135-137.
- 5. 吳紅濤,麻曉林,蔣耀光.沐舒坦針劑治療兔創傷性急性肺損傷的實驗研究.創傷外科雜志,2005,1:57-60.
- 6. 白春學,孫波,主編.急性呼吸窘迫綜合征.上海:復旦大學出版社,2005,56-57.
- 7. 鄭樹森,主編.肝臟移植.北京:人民衛生出版社,2001,339-345.
- 8. 陳曉峰,丁嘉安,高文,等.開胸術后發生急性呼吸窘迫綜合征的病因探討及治療.中華外科學雜志,2003,41:906-908.
- 9. Quinlan GJ,Mumby S,Lamb NJ,et al.Acute respiratory distress syndrome secondary to cardiopulmonary bypass:do compromised plasma iron-binding anti-oxidant protection and thiol levels influence outcome?Crit Care Med,2000,28:2271-2276.
- 10. Stettner S,Ledwozy WA.The effect of Ambroxol on bleomycin-induced changes in phospholipid composition of rat lung surfactant.Acta Physiol Hung,1995,83:181-187.
- 11. 張波,劉又寧.溴環己胺醇對通氣機導致肺損傷保護作用的研究.中華醫學雜志,2000,80:51-53.
- 12. Wesierska-Gadek J,Goetz AE.Role of PARP on iNOS pathway during endotoxin-induced acute lung injury.Intensive Care Med,2004,30:1421-1431.
- 13. Schott R,Chaouat A,Launoy A,et al.Improvement of pulmonary hypertension after liver transplantation.Chest,1999,115:1748-1749.
- 14. Slutsky AS.Acute lung injury(ALI) and the acute respiratory distress syndrome(ARDS).Transfusion Alternatives in Transfusion Medicine,2004,6(suppl):45.
- 15. Kopko PM,Marshall CS,Mackenzie MR,et al.Transfusion-related acute lung injury,report of aclinical look-back investigation,JAMA,2002,287:1968-1971.
- 16. Markart P,Schmidt R,Ruppert C,et al.Ischemic and endotoxin pre-conditioning reduce lung reperfusion injury-induced surfactant alterations.J Heart Lung Transplant, 2005,24:1680-1689.
- 17. 顧小萍,徐福濤,仇毓東,等.原位肝移植大鼠供肝冷缺血時間對受體肺損傷的影響.國際麻醉學與復蘇雜志,2006,1:22-24.
- 18. Barsness KA,Bensard DD,Partrick DA,et al.IL-1beta induces an exaggerated pro-and anti-inflammatory response in peritoneal macrophages of children compared with adults.Pediatr Surg Int,2004,20:238-242.
- 19. Farivar AS,Krishnadasan B,Naidu BV,et al.Endogenous interleukin-4 and interleukin-10 regulate experimental lung ischemia reperfusion injury.Ann Thorac Surg,2003,76:253-259.
- 20. 劉昌,宋宇龍,劉峰,等.大鼠供肝冷缺血時間與肝移植術后受者肺損傷的關系.中華器官移植雜志,2006,3:138-141.