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目的:探讨在发生多器官功能衰竭肥胖创伤患者中应用血管紧张素对患者的保护作用。方法:选取2014年5月至2015年5月在丽水市人民医院就诊的100名患者,纳入标准为BMI>28kg/m2、APACHE II评分>20,在记录患者基本信息如年龄、COPD、CKD疾病史以及创伤严重度评分(ISS)、简明损伤定级标准(AIS)后,患者随机分为两组,ACEI组与非ACEI组,并应用ACEI药物,同时对患者ICU停滞时间(d)、机械通气时间(d)、院内感染(%)以及非感染性并发症(%)进行评估,在28天对患者MODS进行Marshall与Denver评分,最后对患者在28天以及365天的生存率进行随访。结果:患者在年龄、BMI、病史、以及疾病严重程度无明显差异,而在机械通气中,相对于非ACEI组的18±1.3天,ACEI的应用使得患者机械通气时间达到13±1.2天,其余的指标ICU停滞时间(d)、机械通气时间(d)、院内感染(%)被证实在两组中无明显差异。在入院28天后ACEI患者MODS评分Marshall:2.24±1.90、Denver:3.33±2.21明显低于非ACEI组的Marshall:5.25±2.87、Denver:6.50±2.57。同时在对患者28天以及365天的生存率进行监测后发现ACEI能够明显改善患者的28天以及365天的生存率。结论:ACEI在肥胖创伤的MODS患者中可以明显改善患者通气以及MODS评分,同时提高了患者的28天与365天生存率,对患者起到了保护作用。
Objective: To investigate the protective effect of angiotensin on patients with multiple trauma patients with multiple organ failure. Methods: A total of 100 patients were enrolled in Lishui People’s Hospital from May 2014 to May 2015. The inclusion criteria were BMI> 28kg / m2, APACHE II score> 20. The basic information such as age, COPD, CKD disease Patients were randomly divided into two groups: ACEI group and non-ACEI group. ACEI drugs were also used. The ICU standstill time (d), mechanical Ventilation time (d), nosocomial infections (%), and noninfectious complications (%) were assessed. Marshall and Denver scores were scored on patients with MODS at 28 days. Finally, patients were followed up for survival rates of 28 days and 365 days. Results: There were no significant differences in age, BMI, medical history, and severity of illness in patients. In mechanical ventilation, ACEI application resulted in a mean mechanical ventilatory time of 13 ± 1.2 days compared to 18 ± 1.3 days in non-ACEI group. The remaining The ICU standstill (d), duration of mechanical ventilation (d), nosocomial infection (%) were confirmed to be indistinctive in both groups. The MODS scores of Marshall: 2.24 ± 1.90 and Denver: 3.33 ± 2.21 after 28 days of hospital admission were significantly lower than those of non-ACEI group: Marshall: 5.25 ± 2.87 and Denver: 6.50 ± 2.57. At the same time, monitoring the patients ’survival rate at 28 days and 365 days showed that ACEI could significantly improve the patients’ survival rate at 28 days and 365 days. CONCLUSION: ACEI can significantly improve ventilation rate and MODS score in MODS patients with obesity trauma, meanwhile improve the patients’ 28-day and 365-day survival rates and play a protective role in patients.