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目的观察维拉帕米普鲁卡因合剂(维普合剂)防治危重患者手术后急性呼吸窘迫综合征(ARDS)的效果,探讨适宜推广应用防治ARDS的简便、实用、价廉方法。方法符合ARDS高危因素的各科危重手术患者150例,在常规基础综合治疗基础上随机分为3组:维普合剂组给予质量分数为5%的葡萄糖500ml+普鲁卡因1250mg+维拉帕米10mg;普鲁卡因组给予5%葡萄糖500ml+普鲁卡因1250mg;对照组仅给予5%葡萄糖500ml。3组均以0.5ml·h-1·kg-1持续静脉滴注,确诊急性肺损伤(ALI)或ARDS后,维普合剂组和普鲁卡因组的普鲁卡因和维拉帕米剂量均加倍,滴速不变。均应用金科威UT4000F持续无创监测血压(BP)、心电图(ECG)、脉搏血氧饱和度(SpO2)、呼吸及体温,间断测定动脉血气分析和外周血常规。依据全身炎症反应综合征(SIRS)、ALI与ARDS诊断标准确定诊断,并进行SIRS评分和急性生理学与慢性健康状况(APACHE)评分。结果维普合剂组、普鲁卡因组和对照组24hSIRS确诊数分别为11例、26例和42例,组间比较差异均有显著性(P均<0.01);术后72h3组ALI确诊数分别为4例、7例和19例,维普合剂组与普鲁卡因组组间比较差异无统计学意义,维普合剂组和普鲁卡因组与对照组比较差异均有显著性(P均<0.01);术后2周仅对照组有12例确诊ARDS,其中5例并发多器官功能衰竭后死亡,?
Objective To observe the effect of verapamil procaine (WPP) in preventing and treating acute respiratory distress syndrome (ARDS) after operation in critically ill patients, and to explore a simple, practical and inexpensive method suitable for the promotion and application of ARDS. Methods A total of 150 critically ill patients undergoing ARDS were enrolled in this study. They were randomly divided into three groups on the basis of conventional comprehensive treatment: Weibu mixture group received 5% glucose 500ml + procaine 1250mg + verapamil 10mg; The procaine group was given 500ml of 5% glucose and procaine 1250mg; the control group only given 500ml of 5% glucose. The three groups were given intravenous infusion of 0.5ml · h-1 · kg-1. After the diagnosis of acute lung injury (ALI) or ARDS, the dose of procaine and verapamil All doubled, drip rate unchanged. All patients were enrolled in the continuous noninvasive monitoring of blood pressure (BP), electrocardiogram (ECG), pulse oxygen saturation (SpO2), respiration and body temperature, intermittent arterial blood gas analysis and peripheral blood routine using Kingway UT4000F. Diagnosis was based on the SIRS, ALI and ARDS diagnostic criteria, and SIRS scores and acute physiology and chronic health status (APACHE) scores were scored. Results The results of 24hSIRS were statistically significant (P <0.01). The number of confirmed 24SIRS in Weipu Mixture group, procaine group and control group were 11 cases, 26 cases and 42 cases respectively (all P <0.01) 4 cases, 7 cases and 19 cases. There was no significant difference between Weipu Mixture group and procaine group, and there was significant difference between Weipu Mixture group and procaine group and control group (P < 0.01). In the control group, 12 cases were diagnosed with ARDS 2 weeks after operation, of which 5 died after multiple organ failure.