头孢哌酮舒巴坦结合纤支镜肺泡灌洗治疗重症肺部感染的疗效及对患者血清PRA、AngⅡ水平的影响

Effect of cefoperazone sulbactam combined with fiberoptic bronchoalveolar lavage on severe pulmonary infection and serum PRA and Ang Ⅱ levels

目的观察头孢哌酮舒巴坦结合纤维支气管镜(纤支镜)肺泡灌洗治疗肺部感染的效果及其对患者血清肾素(PRA)、血管紧张素Ⅱ(AngⅡ)水平的影响。方法选择2018年1月至2019年4月在西安市北方医院呼吸内科接受治疗的84例严重肺部感染患者作为研究对象,按随机数表法将其分为对照组和联合组各42例。两组患者均给予头孢哌酮舒巴坦静脉滴注,联合组患者同时给予纤支镜吸痰和支气管肺泡灌洗术治疗。比较两组患者的治疗效果及治疗前后的血清PRA、AngⅡ水平。结果治疗后联合组患者的细菌清除率为91.67%,治疗总有效率为92.86%,明显高于对照组的60.61%和73.81%,差异均有统计学意义(P<0.05);两组患者治疗后的白细胞计数(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)、白介素-6 (IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)水平均较治疗前明显降低,且治疗后联合组较对照组降低更明显,差异均有统计学意义(P<0.05);联合组和对照组患者的体温恢复正常时间[(6.16±2.01) d vs (8.86±2.33) d]、血象恢复正常时间[(11.35±3.83) d vs (16.19±5.07) d]、肺部炎症吸收时间[(18.98±4.83) d vs (23.71±5.12) d]和住院时间[(16.30±2.81) d vs (20.94±4.72) d]比较,联合组明显短于对照组,差异均有统计学意义(P<0.05);联合组患者的不良反应发生率为21.43%,略高于对照组的11.90%,但差异无统计学意义(P>0.05);联合组治疗1周后动脉血二氧化碳分压(PaCO2)较治疗前明显降低,动脉血氧分压(PaO2)和动脉血氧饱和度(SpO2)较治疗前明显升高,且联合组治疗后动脉血气分析指标与对照组比较差异均具有统计学意义(P<0.05);两组患者治疗1周后的血清PRA、AngⅡ均较治疗前显著降低,且治疗后联合组和对照组患者的血清PRA [(1.24±0.41) pg/mL vs (1.92±0.60) pg/mL]、AngⅡ[(22.54±6.21) pg/mL vs (37.09±7.16) pg/mL]水平比较,联合组明显低于对照组,差异均有统计学意义(P<0.05)。结论头孢哌酮舒巴坦联合纤支镜治疗严重肺部感染能提高患者的细菌清除率,降低炎症水平,降低肾素-血管紧张素系统活性,降低血清PRA、AngⅡ水平,明显改善动脉血气分析指标,进而可有效控制肺部感染,缩短患者临床症状、体征改善时间和住院时间,而且治疗安全性高,值得临床推广应用。

Objective To observe the effect of cefoperazone sulbactam combined with fiberoptic bronchoalveolar lavage in the treatment of severe pulmonary infection and its effect on serum renin(PRA) and angiotensin Ⅱ(AngⅡ) levels. Methods Eighty-four patients with severe pulmonary infection who were treated in Department of Respiratory Medicine, the Northern Hospital of Xi’an City from January 2018 to April 2019 were randomly divided into control group and combined group(42 cases each) according to the random number table. Both groups were given intravenous drip of cefoperazone and sulbactam, while the combined group received bronchoscopic sputum aspiration and fiberoptic bronchoalveolar lavage. The therapeutic effect and serum PRA and Ang Ⅱ levels before and after treatment were compared. Results The bacterial clearance rate and the total effective rate were 91.67% and 92.86% in the combined group, which were significantly higher than 60.61% and 73.81% in the control group(P<0.05). After treatment, white blood cell(WBC), procalcitonin(PCT), C-reactive protein(CRP), interleukin(IL-6), IL-8, and tumor necrosis factor-α(TNF-α) in the two groups were significantly lower than those before treatment, and the levels in the combined group were significantly lower than those in the control group, with statistically significant differences(P<0.05). The recovery time of body temperature, the recovery time of hemogram, absorption time of pulmonary inflammation, and length of hospital stay in the combined group were significantly shorter than those in the control group(P<0.05):(6.16±2.01) d vs(8.86±2.33) d,(11.35±3.83) d vs(16.19±5.07) d,(18.98±4.83) d vs(23.71±5.12) d,(16.30±2.81) d vs(20.94±4.72) d,repectively. The incidence of adverse reactions in the combined group was 21.43%, slightly higher than 11.90% in the control group, but the difference was not statistically significant(P>0.05). After one week of treatment, the PaO2 of the combined group was significantly lower than that before treatment, and the PaO2 and SpO2 of the combined group were significantly higher than those before treatment;the arterial blood gas analysis indexes in the combined group were significantly different from those in the control group after treatment;the differences were statistically significant(P<0.05).The serum PRA and Ang Ⅱ levels of the two groups were significantly reduced one week of treatment compared with those before treatment(P<0.05), and the serum PRA and Ang Ⅱ levels of the combined group were significantly lower than those of the control group after treatment(P<0.05):(1.24±0.41) pg/mL vs(1.92±0.60) pg/mL,(22.54±6.21) pg/mL vs(37.09±7.16) pg/mL. Conclusion Cefoperazone sulbactam combined with fiberoptic bronchoalveolar lavage can improve the bacterial clearance rate, reduce the level of inflammation, decrease the activity of renin-angiotension system,decrease the level of PRA and angⅡ in serum, improve the indexes of arterial blood gas analysis, and then effectively control the pulmonary infection, shorten the improvement time of clinical symptoms and signs and length of hospital stay. It is safe and worthy of clinical application.