【摘要】 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,?更多还原

【Abstract】 Objective To observe the effect of verapamilprocaine compound （VP） on prevention and treatment of acute respiratory distress syndrome （ARDS） subsequent to high risk operation. Methods Altogether 150 cases of major operations with high risk of ARDS were enrolled for study. They were randomlydivided into three groups. VP group: 5% glucose 500 ml and procaine 1 250 mg and verapamil 10 mg ; procaine group: 5% glucose 500 ml and procaine 1 250 mg; control group: only glucose was given. The injection speed of the three groups were the same, and it was kept at 0.5 ml·h -1 ·kg -1 . The dosages of verapamil and procaine in VP group and procaine group were doubled when the diagnosis of acute lung injury （ALI） or ARDS was confirmed. UT4000F was used in monitoring （noninvasive） blood pressure （BP）, electrocardiogram （ECG）, pulse oxygen saturation （SpO₂）, respiratory rate, and temperature. Blood routine and arterial blood gases measurements were intermittently performed. Diagnosis of systemic inflammatoryresponse syndrome （SIRS）, ALI and ARDS was made respectively according to published diagnosticcriteria. SIRS score and acute physiology and chronic health evaluationⅡ（APACHEⅡ） score were performed. Results Eleven cases in VP group, 26 in procaine group, and 42 in control group manifested symptoms and signs of SIRS. There were notable differences among groups （all P<0.01）. Four patients in VP group, 7 in procaine group, and 19 in control group were shown to develop ALI. Significant difference was found between control and VP or procaine group （both P<0.01）, but no significant difference was found between procaine group and VP group. Twelve cases were complicated with ARDS in control group 2 weeks after the operation, and among them 5 died of mutiple organ failure. There was significant difference between control group and VP group or procaine group （both P<0.01）. Two patients were complicated with acute renal failure in VP group, 2 in procaine group, and 5 in control group. Conclusion The VP can interrupt SIRS to develop ALI, then ARDS and multiple organ dysfunction syndrome（MODS）, and thus prevents and cures ARDS.更多还原