碳酸氢钠联合卡泊芬净治疗真菌性肺炎的疗效观察

Clinical observation of sodium bicarbonate combined with caspofungin in treatment of fungal pneumonia

目的探讨碳酸氢钠注射液联合注射用醋酸卡泊芬净治疗真菌性肺炎的临床疗效。方法选取2017年2月—2018年2月在南京大学医学院附属南京鼓楼医院集团宿迁市人民医院治疗的真菌性肺炎患者78例,根据用药方案的不同分为对照组(39例)和治疗组(39例)。对照组患者静脉滴注注射用醋酸卡泊芬净,首日剂量70 mg加入250 m L生理盐水,之后减至50 mg/d;治疗组在对照组基础上气道内持续泵注2.5%碳酸氢钠注射液2~5 m L/h。两组均经过7 d治疗。观察两组患者临床疗效,同时比较治疗前后两组患者临床症状改善情况、动脉血二氧化碳分压(p CO_2)和动脉血氧分压(p O_2)值及真菌清除率。结果治疗后,对照组临床有效率为82.05%,显著低于治疗组的97.44%,两组比较差异具有统计学意义(P<0.05)。治疗后,治疗组患者的体温恢复时间、咳嗽消退时间和肺部湿罗音消退时间均显著短于对照组,两组比较差异具有统计学意义(P<0.05)。治疗后,两组患者p CO_2明显降低(P<0.05),p O_2明显升高(P<0.05),且治疗后治疗组患者p CO_2和p O_2值明显优于对照组(P<0.05)。治疗后,对照组的真菌清除率为71.79%,显著低于治疗组的92.31%,两组患者比较差异具有统计学意义(P<0.05)。结论碳酸氢钠注射液联合注射用醋酸卡泊芬净治疗真菌性肺炎可有效改善患者临床症状,提高真菌清除率,具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of sodium bicarbonate combined with caspofungin in treatment of fungal pneumonia.Methods Patients（78 cases）with fungal pneumonia in Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group Affiliated to Medicine School of Nanjing University from February 2017 to February 2018 were randomly divided into control（39 cases）and treatment（39 cases）groups.Patients in the control group were iv administered with Caspofungin Acetate for injection,the first day dose was 70 mg added into normal saline 250 m L,then decreased to 50 mg/d.Patients in the treatment group were airway continuously infused with 2.5%Sodium Bicarbonate Injection on the basis of the control group,2—5 m L/h.Patients in two groups were treated for 7 d.After treatment,the clinical efficacy was evaluated,and the improvement of clinical symptoms,p CO2 and p O2value,the fungal clearance rate in two groups before and after treatment were compared.Results After treatment,the clinical efficacy in the control group was 82.05%,which was significantly lower than 97.44%in the treatment group,and there were differences between two groups（P〈0.05）.After treatment,the temperature recovery time and disappeared time of cough and pulmonary rales in the treatment group after treatment were significantly earlier than those in the control group,with significant difference between two groups（P〈0.05）.After treatment,the p CO2 value in two groups was significantly decreased（P〈0.05）,and p O2 value was significantly increased（P〈0.05）,and the p CO2 and p O2 value in the treatment group after treatment were significantly better than those in the control group（P〈0.05）.After treatment,the fungal clearance rate in the treatment group was 71.79%,which was significantly lower than 92.31%in the control group,with significant difference between two groups（P〈0.05）.Conclusion Sodium bicarbonate combined with caspofungin in treatment of fungal pneumonia can effectively improve the clinical symptoms and raise the fungal clearance rate,which has a certain clinical application value.