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目的:观察尼可地尔对急性呼吸窘迫综合征(ARDS)患者的心肌保护作用。方法:采用前瞻性随机对照研究方法,选择ARDS患者40例,随机分为治疗组(20例)和对照组(20例)。治疗组给予尼可地尔10 mg胃管注入3次/d,共5 d,余治疗两组相同。观察两组治疗前后超敏C反应蛋白(hs-CRP)、超敏心肌肌钙蛋白(hscTn)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及28 d病死率差异。结果:①两组患者性别、年龄、治疗前APACHEⅡ评分、hs-CRP及hs-cTn等基础状态无显著差异;②治疗后治疗组hs-CRP[11.35(3.63)g/L:13.50(5.93)g/L,P=0.027、hs-cTn[45.10(27.40)ng/L:65.70(74.58)ng/L,P=0.023较对照组明显降低;③治疗后两组APACHEⅡ评分[(21.05±8.58):(18.70±11.21)]及28 d死亡率(25%:15%)无统计学差异。结论:尼可地尔可减轻ARDS患者的心肌损害,保护心肌,但不能降低患者的28 d病死率。
Objective: To observe the myocardial protection effect of Nicorandil in patients with acute respiratory distress syndrome (ARDS). Methods: Forty patients with ARDS were randomly divided into treatment group (n = 20) and control group (n = 20) by prospective randomized controlled study. The treatment group was given nicorandil 10 mg gastric tube 3 times / d, a total of 5 d, the remaining two groups of the same treatment. The changes of hs-CRP, hscTn, APACHEⅡ and 28-day mortality were observed before and after treatment. Results: ① There was no significant difference in gender, age, pre-treatment APACHEⅡscore, hs-CRP and hs-cTn basal state between two groups. ② After treatment, the hs-CRP level in the treatment group was 11.35 (3.63) g / (P <0.05); (2) After treatment, the APACHEⅡscores of both groups [(21.05 ± 8.58) ng / L, P = 0.027 and hs-cTn45.10 (27.40) ng / L were significantly lower than those of the control group : (18.70 ± 11.21)] and 28-day mortality (25%: 15%). CONCLUSION: Nicorandil can reduce myocardial damage and protect myocardium in patients with ARDS, but can not reduce the 28-day mortality in patients with ARDS.