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目的:探讨严重烧伤伴中重度吸入性损伤患者早期联合使用大剂量乌司他丁与沐舒坦的临床疗效。方法:选择2003年5月~2013年5月在我院接受治疗的185例严重烧伤伴中重度吸入性损伤患者,随机分为两组,治疗组93例,对照组92例。两组患者在确诊为中重度吸入性损伤后,立即给予传统常规治疗:吸氧、视情尽早预防性气管切开、湿化气道及气道灌洗、翻身拍背吸痰、呼吸机辅助呼吸等。治疗组在常规治疗的基础上给予乌司他丁40万单位,每隔8h静脉滴注,沐舒坦450 mg,每隔12h微泵静推;对照组给予乌司他丁10万单位,每隔8h静滴,沐舒坦30 mg,每隔8h静滴,疗程为10天,比较两组患者急性肺损伤(ALI)的发生率、急性呼吸窘迫综合征(ARDS)的发生率、呼吸机使用时间、死亡率。结果:治疗组93例患者,治愈92例,死亡1例,死亡率为1.08%(1/93),治疗过程中发生ALI34例,ARDS12例,呼吸机使用时间为(4.2±2.1)d。对照组92例患者治愈88例,死亡4例,死亡率率为4.35%(4/92),治疗过程中发生ALI43例,ARDS17例,呼吸机使用时间为(8.2±2.7)d。两组患者ALI发生率、ARDS发生率、呼吸机使用时间、治愈率差异均有统计学意义(P<0.05)。结论:对于严重烧伤伴中重度吸入性损伤的患者,在气管切开的前提下,给予常规传统治疗的同时,采用大剂量乌司他丁与沐舒坦早期联合使用给药,能够明显的提高治愈率,降低并发症,值得在临床上广泛推广应用。
Objective: To investigate the clinical efficacy of early combination of high-dose ulinastatin and ambroxol on patients with severe burn and moderate-severe inhalation injury. Methods: A total of 185 severe burn patients with moderate to severe aspiration injury who were treated in our hospital from May 2003 to May 2013 were randomly divided into two groups: treatment group (n = 93) and control group (n = 92). Two groups of patients diagnosed as moderate to severe inhalation injury, immediately given the conventional treatment: oxygen, as early as possible prophylactic tracheotomy, humidification airway and airway lavage, stand up shoot back suction sputum, ventilator-assisted Breathing and so on. The treatment group was given ulinastatin 400,000 units on the basis of routine treatment, every 8h intravenous infusion, mucosolvan 450 mg, every 12h micro-pump push; control group was given ulinastatin 100,000 units, every 8h intravenous infusion, ambroxol 30 mg intravenous drip every 8h for 10 days. The incidence of acute lung injury (ALI), incidence of acute respiratory distress syndrome (ARDS), ventilator use time ,mortality rate. Results: In the treatment group, 93 patients were cured, 92 were cured and 1 died. The mortality rate was 1.08% (1/93). There were 34 ALI cases, 12 ARDS cases and 4.2 ± 2.1 days ventilator time. In the control group, 88 patients were cured and 4 died. The mortality rate was 4.35% (4/92). ALI occurred in 43 cases, ARDS in 17 cases and ventilator time in (8.2 ± 2.7) days. The incidence of ALI, the incidence of ARDS, the duration of ventilator and the cure rate of the two groups were statistically significant (P <0.05). CONCLUSIONS: For patients with severe burns associated with moderate or severe inhalation injury, conventional conventional therapy with high dose of ulinastatin and mucosolvan given in combination with early tracheotomy can significantly improve the cure rate Rate, reduce complications, it is widely used in clinical practice.