小剂量多巴胺对重症肺炎康复进程的影响研究

doi:10.3760/cma.j.issn.1007-1245.2023.24.009

摘要/Abstract

摘要：

目的　观察小剂量多巴胺对重症肺炎患者康复进程的影响。方法　选取南阳市第一人民医院2020年10月至2022年10月收治的90例重症肺炎患者进行随机对照试验，采用电脑随机法分为常规组（45例）和试验组（45例）。常规组中男30例，女15例，年龄（67.52±5.23）岁，仅实施常规治疗；试验组中男31例，女14例，年龄（66.21±5.31）岁，在对照组基础上采用小剂量多巴胺辅助治疗（按1~3 μg/kg剂量取多巴胺加入至50 ml浓度为5%的葡萄糖溶液中稀释后经静脉滴注，24 h/次）。比较两组患者的炎症因子、肺功能改善情况，治疗后康复进程及预后情况。采用χ²检验、t检验进行统计比较。结果　治疗前，两组患者的血清炎症因子差异无统计学意义（P>0.05）；治疗后，试验组的白细胞计数（WBC）为（5.25±1.41）×10⁹/L，Toll样受体2（TLR2）相对表达量为（30.13±5.24），Toll样受体4（TLR4）相对表达量为（32.45±5.41），均低于常规组［（6.65±2.14）×10⁹/L、（33.19±5.23）、（35.15±5.26）］，差异均有统计学意义（均P<0.05）。治疗前，两组患者的心肺功能差异无统计学意义（P>0.05）；治疗后，试验组的第一秒用力呼气容积（FEV1）为（84.45±10.21）%，用力肺活量（FVC）为（2.88±0.46）L，呼气峰值流速（PEF）为（482.45±50.63）L/min，均高于常规组［（78.44±10.31）%、（2.24±0.35）L、（445.23±50.16）L/min］，差异均有统计学意义（均P<0.05）。在不同治疗方案下，试验组咳嗽消失时间为（4.45±1.23）d，退热时间为（3.26±0.72）d，呼吸困难改善时间为（2.45±0.46）d，肺部啰音消失时间为（2.58±0.26）d，住院时间为（14.42±3.39）d，均低于常规组［（5.66±2.08）d、（4.24±1.06）d、（3.06±0.72）d、（3.11±0.63）d、（17.72±4.39）d］，差异均有统计学意义（均P<0.05）。在不同治疗方案下，试验组的并发症发生率为8.89%（4/45），低于常规组22.22%（10/45），差异有统计学意义（P<0.05）。试验组的药物相关不良反应发生率为13.33%（6/45），略高于常规组11.11%（5/45），差异无统计学意义（P>0.05）。结论　小剂量多巴胺能有效缓解重症肺炎患者的炎症反应，对促进肺功能恢复、加快康复进程并降低并发症发生率均有积极意义，且此药安全性较高，未明显增强其药物不良反应发生风险。

关键词:

肺功能, 重症肺炎, 多巴胺, 康复进程, 预后情况

Abstract:

Objective　To study the effect of a low dose of dopamine on rehabilitation process of patients with severe pneumonia. Methods　Ninety patients with severe pneumonia treated at Nanyang First People's Hospital from October 2020 to October 2022 were selected for the randomized controlled trial, and were divided into a conventional group (45 cases) and an experimental group (45 cases) by the computer random method. There were 30 males and 15 females in the conventional group; they were (67.52±5.23) years old. There were 31 males and 14 females in the experimental group; they were (66.21±5.31) years old. The conventional group took conventional treatment; in addition, the experimental group took low-dose dopamine adjuvant treatment (the dopamine was added to 50 ml 5% glucose solution at 1-3 μg/kg for intravenous dripping 24 h/time). The inflammatory factors, lung function improvement, rehabilitation progresses, and prognosis after the treatment were compared between the two groups. χ² and t tests were applied. Results　Before the treatment, there were no statistical differences in the levels of serum inflammatory factors between the two groups (all P>0.05); after the treatment, the white blood cell count (WBC) and relative expression levels of Toll like receptors 2 (TLR2) and 4 (TLR4) in the experimental group were lower than those in the conventional group[(5.25±1.41)×10⁹/L vs. (6.65±2.14)×10⁹/L, (30.13±5.24) vs. (33.19±5.23), and (32.45±5.41) vs. (35.15±5.26)], with statistical differences (all P<0.05). Before the treatment, there were no statistical differences in the cardiopulmonary function indicators between the two groups (all P>0.05); after the treatment, the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and peak rate of expiration flow (PEF) in the experimental group were higher than those in the conventional group [(84.45±10.21)% vs. (78.44±10.31)%, (2.88±0.46)L vs. (2.24±0.35)L, and (482.45±50.63) L/min vs. (445.23±50.16) L/min], with statistical differences (all P<0.05). The cough disappearance time, fever relief time, dyspnea improvement time, lung rale disappearance time, and hospital stay in the experimental group were shorter than those in the conventional group [(4.45±1.23) d vs. (5.66±2.08) d, (3.26±0.72)d vs. (4.24±1.06) d, (2.45±0.46) d vs. (3.06±0.72) d, (2.58±0.26) d vs. (3.11±0.63) d, and (14.42±3.39) d vs. (17.72±4.39) d], with statistical differences (all P<0.05). The incidence of complications in the experimental group was lower than that in the conventional group [8.89% (4/45) vs. 22.22% (10/45)], with a statistical difference (P<0.05). The incidence of drug-related adverse reactions in the experimental group was 13.33% (6/45), and that in the conventional group was 11.11% (5/45), with no statistical difference (P>0.05). Conclusion　Low-dose dopamine can effectively alleviate the inflammatory reaction in patients with severe pneumonia, and is of positive significance in promoting their recovery of lung function, speeding up the recovery process, and reducing the incidence of complications. Moreover, this drug is safe and does not significantly increase the risk of adverse drug reactions.

Key words:

Lung function, Severe pneumonia, Dopamine, Rehabilitation process, Prognostic situation

江宁李静.

小剂量多巴胺对重症肺炎康复进程的影响研究 [J]. 国际医药卫生导报, 2023, 29(24): 3566-3570.

Jiang Ning, Li Jing.

Effect of a low dose of dopamine on rehabilitation process of patients with severe pneumonia [J]. International Medicine and Health Guidance News, 2023, 29(24): 3566-3570.

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