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asbryobvrz · Wysłany: Śro 20:36, 09 Mar 2011

Ambroxol on the control of lung infection in patients with severe brain injury Clinical study

% -67.4% Xi, up 78.9% [3】, is in addition to primary brain damage. 358 Zhejiang Traumatic Surgery December 2004 Khon! Parameters of SVM Khon Lan Zhu g! plastic seat:,[link widoczny dla zalogowanych]! Lan Zhu !!:!!!: Fort !!!!! Table 1 Basic clinical data of the two groups were pulmonary infection (patients) in treatment control groups 5101 (death 0 cases) 3 (1 died) 4 (1 died) 7 (3 died) the total number of 1716 cases of lung infection and died of 22 injuries had led to deaths outside of one of the major complications . Its mechanism are: ① the hypothalamus, brain stem injury that sympathetic nerve activity and cause systemic release of a large number of medium and pulmonary vasoconstriction, resulting in the early stage of neurogenic pulmonary congestion, pulmonary edema; ② after injury (surgery) duration of coma patients long or long-term bed rest (hemiplegia), resulting in decreased vital capacity, pulmonary sputum hypostatic. Alveolar atelectasis; ⑧ coma patients, high intracranial pressure caused by misuse of vomit into the lungs; ④ unconscious patient swallowing reflex cough and sputum resulted in weakened or disappeared difficult to discharge. At the same time due to suppressed immune function after trauma to cause lung infection, lung infection, in turn,[link widoczny dla zalogowanych], increase the secondary brain damage: ① lung infection bacterial toxins affect the brain microcirculation, so that cerebral hypoperfusion, venous disorders, lead to increased brain edema; ② purulent sputum airway obstruction, atelectasis, etc., causing decreased oxygen exchange capacity, causing hypoxemia, so that cerebral ischemia and hypoxia worsened. This vicious circle caused deaths. Consequently, the effective control of pulmonary infection patients to improve ventilation and increase brain oxygen supply, so as to reduce secondary brain injury, and ultimately improve the prognosis important means of reducing mortality. Pulmonary infection occurred 2 to 10 days after injury, and the event is often difficult to control. Reasons: ① the diversity of bacterial infection,[link widoczny dla zalogowanych], a patient will appear at different times in different bacteria; ② resistant strains soon appeared; ⑧ opportunistic pathogen rise. Therefore,[link widoczny dla zalogowanych], how to control the infection has been widely appreciated, the main clinical to comprehensive treatment, such as: ① to maintain airway patency, early tracheotomy; ② removal of intracranial hematoma intracranial pressure; ③ early and effective use of antibiotics, nutrition support; ④ enhance airway management and care. Hospital from January 2002 from severe head injury patients on the basis of the comprehensive treatment of randomized ambroxol used acupuncture in the control and treatment of pulmonary infection on the effect is obvious. Its mechanism of action: ① ambroxol stimulates synthesis of alveolar type Ⅱ cells and secretion of surface active substances, reduces alveolar surface tension and adhesion of mucus,[link widoczny dla zalogowanych], improve airway mucociliary nonciliated zone areas and the delivery of sputum; ② role in airway secretory cells, mucous and serous secretion rate regulation, the slurry secretion, ciliary activity space so that the increase in ciliary beat frequency and intensity increased transport capacity increased, and thus easier to eliminate mucus; ③ can improve antibiotic in bronchial secretions concentrations, faster to kill bacteria, reduce the time of antibiotic treatment; ④ have antioxidant and anti-inflammatory effects, can scavenge oxygen free radicals and inhibiting the release of inflammatory mediators, reduce lung injury. The experiments show the application of ambroxol after the lung infection was significantly lower than the control group (P <O.05), but significantly higher cure rate of pulmonary infection, and ultimately the patient mortality was due to lung infection lower than the control group (P <O.05). From the age distribution, because patients older than 50 years old and frail, complicated by pulmonary infection; treatment and prognosis of infection control group (mortality) better than the control group. Surgery or not on the occurrence and control of lung infection was not significant, Table 2. Therefore, patients with severe traumatic brain injury, may recommend use of ambroxol in control lung infection. The clinical data of this set of experiments but few, and non-prospective studies, there may be some bias, pending further discussion.