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目的观察卡托普利和硝苯地平治疗重症胸外伤致急性肺损伤(ALI)合并高血压患者的血压控制情况。方法 2010年1月至2015年12月,入选沈阳医学院附属中心医院胸外重症监护病房严重创伤致ALI,且合并2级以上高血压患者105例;分为卡托普利组(常规治疗基础上+卡托普利片12.5~50.0mg/次,3次/d,口服或鼻饲,n=51)和硝苯地平组(常规治疗基础上+硝苯地平缓释片10~20mg/次,3次/d,口服或鼻饲,n=54)。两组均治疗7d。观察两组患者的呼吸频率、氧分压、急性生理与慢性健康评分(APACHEⅡ)、创伤严重程度评分(ISS)、机械通气时间、住重症监护病房时间、急性呼吸窘迫综合征(ARDS)的发生率和病死率。结果治疗7d后,卡托普利组呼吸频率[(15.3±5.4)比(22.4±5.4)次/min]、氧分压[(78.3±12.2)比(61.5±12.6)mm Hg]、机械通气时间[(85.4±25.4)比(114.5±22.5)h]、住重症监护病房时间[(5.4±3.1)比(9.5±4.4)d]均优于硝苯地平组,ARDS发生率(37.2%比57.4%)和病死率均(0%比14.8%)低于硝苯地平组(P<0.05);而两组血压控制总有效率差异无统计学意义。结论在治疗重症胸外伤致创伤后ALI伴高血压的患者中,控制高血压满意且无差异的前提下,卡托普利较硝苯地平更利于ALI的治疗。
Objective To observe the effects of captopril and nifedipine on blood pressure control in patients with acute lung injury (ALI) complicated with essential chest injury. Methods From January 2010 to December 2015, a total of 105 ALI patients with severe traumatic injuries in the intensive care unit of the Central Hospital of Shenyang Medical College were enrolled in this study. The patients were divided into captopril group (routine treatment basis Nifedipine + nifedipine group (nifedipine sustained-release tablets 10 ~ 20mg / time, nifedipine + nifedipine + nifedipine + 3 times / d, orally or nasally, n = 54). Both groups were treated for 7 days. Respiratory rate, partial pressure of oxygen, acute physiology and chronic health score (APACHE II), severity of injury (ISS), duration of mechanical ventilation, duration of intensive care unit, and acute respiratory distress syndrome (ARDS) Rate and fatality rate. Results After 7 days of treatment, the respiratory rate in captopril group was significantly higher than that in captopril group (15.3 ± 5.4 vs. 22.4 ± 5.4) / min and oxygen partial pressure (78.3 ± 12.2 vs 61.5 ± 12.6 mmHg) The mean time to ARDS was (85.4 ± 25.4) vs (114.5 ± 22.5) h and ICU stay (5.4 ± 3.1) vs. (9.5 ± 4.4) days, respectively 57.4%) and mortality (0% vs 14.8%) were lower than those of nifedipine group (P <0.05). There was no significant difference in the total effective rate of blood pressure control between the two groups. Conclusions Captopril is more effective than nifedipine in the treatment of ALI in patients with traumatic ALI and severe hypertension after satisfactory treatment of hypertension without any difference.