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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,将40例ARDS患者随机分为治疗组与对照组,每组20例。治疗组给予尼可地尔10mg,胃管注入,3次/日,共5d,其他治疗两组相同。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(hs-cTn)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及28d病死率。结果治疗组治疗后hs-CRP、hs-cTn明显低于治疗前(P<0.01),而对照组治疗前后hs-CRP、hscTn差异无统计学意义(P>0.05),治疗后治疗组hs-CRP、hs-cTn较对照组明显降低(P<0.05)。治疗后两组APACHEⅡ评分及28d病死率差异无统计学意义。二元Logistic回归分析显示治疗后hs-CRP[exp(B)=0.941,P=0.032]、hs-cTn[exp(B)=0.976,P=0.009]、APACHEⅡ评分[exp(B)=0.882,P=0.010]是患者28d病死率的预测因子。结论尼可地尔可以减轻ARDS患者的心肌损害,但不能降低患者的28d病死率。
Objective To observe the myocardial protective effects of nicorandil in patients with acute respiratory distress syndrome (ARDS). Methods Forty ARDS patients were randomly divided into treatment group and control group, with 20 cases in each group by prospective randomized controlled study. The treatment group given Nicorandil 10mg, gastric tube injection, 3 times / day, a total of 5d, the other treatment of the same two groups. The levels of hs-CRP, hs-cTn, APACHEⅡ and 28-day mortality were observed before and after treatment in both groups. Results The hs-CRP and hs-cTn in the treatment group were significantly lower than those before treatment (P <0.01), but there was no significant difference in hs-CRP and hscTn before and after treatment in the treatment group (P> 0.05) CRP, hs-cTn than the control group was significantly lower (P <0.05). There was no significant difference in APACHEⅡscore and 28d mortality between the two groups after treatment. Logistic regression analysis showed that hs-CRP [exp (B) = 0.941, P = 0.032], hs-cTn [exp (B) = 0.976, P = 0.009] and APACHEⅡ score [exp P = 0.010] is a predictor of 28-day mortality in patients. Conclusion Nicorandil can reduce myocardial damage in patients with ARDS, but can not reduce the patient’s 28d mortality.