头孢曲松钠在急性重症肺炎患者治疗中的应用研究

Application of Ceftriaxone Sodium in the Treatment of Patients with Acute Severe Pneumonia

目的研究头孢曲松钠在急性重症肺炎(Acute severe Pneumonia,ASP)患者治疗中的应用效果。方法选择该院2015年1月-2018年12月收治的ASP患者106例,按照随机数字表法分为头孢曲松钠组(n=53)、对照组(n=53),对照组行常规治疗,头孢曲松钠组在常规治疗同时给予头孢曲松钠治疗。观察两组机械通气、肺部啰音消失、体温恢复正常、三凹征消失、住院等恢复指标的持续时间。治疗前后最大吸气压、用力肺活量(FVC)、呼气峰流速(PEF)、第1秒用力呼气量(FEV1)、最大呼气压等肺功能指标,CD4^+、CD8^+、CD4^+/CD8^+等T细胞;CRP、IL-6、TNF-α、IL-1β等炎性因子。结果头孢曲松钠组机械通气、肺部啰音消失、体温恢复正常、三凹征消失、住院等恢复指标的持续时间[(9.33±0.94)d、(5.71±0.60)d、(4.24±0.44)d、(5.02±0.53)d、(18.37±1.90)d]均短于对照组[(13.47±1.37)d、(8.75±0.88)d、(6.79±0.68)d、(8.95±0.92)d、(25.27±2.68)d](t=15.126、18.134、19.339、18.454、10.864,P=0.000、0.000、0.000、0.000、0.000)。治疗后,头孢曲松钠组最大吸气压、最大呼气压、FVC、PEF、FEV1[(80.17±8.14)%、(44.09±4.51)%、(3.72±0.40)V/L、(4.90±0.51)%、(3.02±0.34)V/L]均大于对照组[(68.02±6.91)%、(37.36±3.81)%、(2.83±0.30)V/L、(3.82±0.40)%、(2.15±0.23)V/L](t=6.236、9.218、9.183、9.322、13.864,P=0.000、0.000、0.000、0.000、0.000),头孢曲松钠组CRP、IL-6、TNF-α、IL-1β[(33.57±3.42)mg/L、(344.85±35.26)Pg/mL、(48.18±4.92)Pg/mL、(158.32±16.44)Pg/mL]水平均低于对照组[(42.51±4.35)mg/L、(379.51±39.6)Pg/mL、(65.27±6.61)Pg/mL、(187.26±19.36)Pg/mL](t=12.173、4.649、11.028、5.667,P=0.000、0.000、0.000、0.000)。治疗后,头孢曲松钠组CD4^+、CD4^+/CD8^+水平[(50.41±5.18)%、(1.92±0.20)]均高于对照组[(42.29±4.34)%、(1.40±0.16)](t=7.239、13.155,P=0.000、0.000),CD8^+(26.32±2.73)%水平低于对照组(30.16±3.22)%(t=9.454,P=0.000)。头孢曲松钠组总有效率(90.57%)大于对照组(73.58%)(χ^2=6.257,P=0.006)。结论头孢曲松钠治疗ASP可有效清除患者炎性因子,提高免疫能力,改善肺功能,缩短患者恢复时间,疗效显著。

Objective To study the effect of ceftriaxone sodium in the treatment of patients with acute severe pneumonia(ASP). Methods 106 patients with ASP who were admitted to the hospital from January 2015 to December 2018, according to random numbers table,they were divided into ceftriaxone sodium group(n=53) and control group(n=53). The control group received routine treatment. The ceftriaxone sodium group was treated with ceftriaxone sodium at the same time. The duration of recovery indicators such as mechanical ventilation, disappearance of lung arpeggio, normal temperature recovery, disappearance of the three concaves, and hospitalization were observed. Pulmonary function indexes such as maximum inspiratory pressure, forced vital capacity(FVC), peak expiratory flow rate(PEF), forced expiratory volume in 1 second(FEV1), maximum expiratory pressure before and after treatment, CD4^+, CD8^+, CD4^+/CD8^+, etc.;CRP, IL-6, TNF-α, IL-1β and other inflammatory factors;Results in the ceftriaxone sodium group mechanical ventilation,lung snoring disappeared, body temperature returned to normal, three concave signs disappeared, hospitalization and other recovery indicators continued time [(9.33±0.94)d,(5.71±0.60)d,(4.24±0.44)d,(5.02±0.53)d,(18.37±1.90)d] was shorter than the control group[(13.47±1.37)d,(8.75±0.88)d,(6.79±0.68)d,(8.95±0.92)d,(25.27±2.68)d](t=15.126, 18.134, 19.339, 18.454, 10.864, P=0.000, 0.000,0.000, 0.000, 0.000). After treatment, the maximum inspiratory pressure, maximum expiratory pressure, FVC, PEF, FEV1, maximum expiratory pressure [(80.17 ±8.14)%,(44.09 ±4.51)%,(3.72 ±0.40) V/L,(4.90 ±0.51)%,(3.02 ±0.34) V/L] of ceftriaxone sodium group,were greater than the control group [(68.02±6.91)%,(37.36±3.81)%,(2.83±0.30) V/L,(3.82±0.40)%,(2.15 ±0.23)V/L](t=6.236, 9.2189.183, 9.322, 13.864, P =0.000,0.000, 0.000, 0.000, 0.000), ceftriaxone sodium CRP, IL-6, TNF-α, IL-1β [(33.57 ±3.42) mg/L,(344.85±35.26) Pg/mL,(48.18±4.92) Pg/mL,(158.32±16.44) Pg/mL], were lower than the control group [(42.51±4.35) mg/L,(379.51±39.6) Pg/mL,(65.27±6.61) Pg/mL,(187.26±19.36) Pg/mL](t=12.173, 4.649, 11.028, 5.667, P=0.000, 0.000, 0.000, 0.000). After treatment, CD4^+, CD4^+/CD8^+levels in the ceftriaxone sodium group [(50.41±5.18)%,(1.92±0.20)] were higher than those in the control group [(42.29±4.34)%,(1.40±0.16)](t=7.239, 13.155, P=0.000, 0.000), CD8^+(26.32±2.73)%, lower than the control group(30.16±3.22)%(t =9.454, 0.000). The total effective rate of ceftriaxone sodium group(90.57%) was higher than that of the control group(73.58%)(χ^2=6.257, P=0.006). Conclusion Ceftriaxone sodium can effectively remove inflammatory factors, improve immunity and improve lung function, shortening the recovery time of patients, the effect is remarkable.