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目的:探究有创通气与大剂量沐舒坦治疗脑卒中后重症肺炎的疗效及对脑神经功能的影响。方法:于2013年6月~2016年2月期间,选择广州医科大学附属第四医院呼吸重症医学科收治老年脑卒中合并重症肺炎患者76例为研究对象,采用随机数字法将所有研究对象分为观察组(40例)和对照组(36例);两组患者均给予常规治疗及有创通气,观察组患者给予大剂量沐舒坦治疗,对照组患者给予小剂量剂量沐舒坦治疗;观察并比较两组患者神经功能恢复情况、治疗情况、肺炎严重程度、记录氧分压(PaO_2)、二氧化碳分压(PaCO_2)、C反应蛋白(CRP)水平。结果:两组患者治疗前PaO_2、PaCO_2、肺炎严重程度评分(CURB-65)及CRP水平无差异(P>0.05);治疗后两组患者PaCO_2、CURB-65及CRP水平均显著降低,PaO_2水平显著升高;且观察组患者PaCO_2、CURB-65及CRP水平低于对照组,PaO_2水平显著高于对照组(P<0.05);治疗前两组患者脑卒中神经功能损伤程度评分(NFDS)及美国国立卫生院脑卒中评分(NIHSS)无差异(P>0.05);治疗后两组患者NFDS及NIHSS评分均降低(P<0.05),两组间NFDS及NIHSS评分无差异(P>0.05);治疗后观察组患者机械通气时间、抗生素使用时间、症状缓解时间及ICU住院时间均低于对照组(P<0.05)。结论:有创通气联合大剂量沐舒坦治疗脑卒中后重症肺炎疗效确切,能够提高患者脑神经功能,值得在临床应用推广。
Objective: To investigate the curative effect of invasive ventilation and high-dose ambroxol on severe pneumonia after stroke and its effect on the function of cranial nerves. Methods: From June 2013 to February 2016, 76 patients with senile stroke complicated with severe pneumonia admitted to Respiratory Critical Care Medicine Hospital of the Fourth Affiliated Hospital of Guangzhou Medical University were selected as research objects. All subjects were divided into The observation group (40 cases) and the control group (36 cases). The two groups were given conventional therapy and invasive ventilation. The observation group was treated with high-dose ambroxol and the control group was treated with low-dose ambroxol. Observation and comparison The recovery of neurological function, treatment, severity of pneumonia, PaO_2, PaCO_2 and CRP were recorded in two groups. Results: The PaCO 2, PaCO 2, CURB-65 and CRP levels were not significantly different between the two groups before treatment (P> 0.05). The levels of PaCO 2, CURB-65 and CRP in the two groups were significantly decreased, The levels of PaCO_2, CURB-65 and CRP in the observation group were lower than those in the control group, and the levels of PaO_2 in the observation group were significantly higher than those in the control group (P <0.05). The scores of neurological impairment (NFDS) There was no significant difference in NIHSS score between the two groups (P> 0.05). NFDS and NIHSS scores decreased after treatment in both groups (P <0.05). There was no difference between the two groups in NFDS and NIHSS scores (P> 0.05). After treatment, the observation group patients with mechanical ventilation time, antibiotic use time, symptom relief time and hospital stay in ICU were lower than the control group (P <0.05). Conclusion: The combination of invasive ventilation and high-dose Mucosolvan is effective in treating post-stroke severe pneumonia. It can improve the neurological function of patients and is worth popularizing in clinic.