胸腺五肽治疗重症肺炎合并脓毒血症的临床疗效及对血清因子的影响

Clinical efficacy of thymopentin in treatment of severe pneumonia complicated with sepsis and its effect on serum factors

目的探讨胸腺五肽治疗重症肺炎合并脓毒血症的临床疗效及对血清因子的影响。方法选取2018年1月—2020年10月天津中医药大学第一附属医院重症监护室收治的70例重症肺炎合并脓毒血症患者,按照随机数字表法分为对照组和治疗组,每组各35例。对照组实施常规治疗,治疗组在常规治疗基础上静脉滴注胸腺五肽注射液,将10 mg加入至0.9%氯化钠注射液2 mL中,1次/d,持续7 d。观察两组的临床疗效和转归时间,比较两组治疗前后免疫功能指标、炎症因子指标、肺功能指标和动脉血气指标的变化情况。结果治疗后,治疗组患者的总有效率为97.14%,显著高于对照组80.00%(P<0.05)。治疗后,治疗组休克逆转时间、机械通气时间、住院时间均显著短于对照组(P<0.05)。治疗后,两组CD3+、CD4+/CD8+与治疗前相比均显著增高,但降钙素原(PCT)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)显著降低(P<0.05);治疗后,治疗组免疫功能和炎性因子指标改善均优于对照组(P<0.05)。治疗后,两组1秒用力呼吸容积(FEV1)、FEV1与肺活量比值(FEV1/FVC)、动脉血氧分压(pO2)均显著增高,而动脉血二氧化碳分压(pCO2)显著降低(P<0.05);治疗后,治疗组肺功能指标和动脉血气指标改善优于对照组(P<0.05)。结论胸腺五肽用于重症肺炎合并脓毒血症患者中,可改善患者免疫功能,减轻炎症反应、肺通气障碍、动脉血气紊乱,从而尽快逆转患者休克状态,缩短其住院时间,且不良反应少,安全性可靠。

Objective To explore the clinical efficacy of thymopentin in treatment of severe pneumonia complicated with sepsis and its effect on serum factors. Methods A total of 70 patients with severe pneumonia complicated with sepsis admitted to the ICU of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to October 2020 were selected and randomly divided into control group and treatment group according to random number table method, with 35 patients in each group. The control group was given routine treatment, and patients in the treatment group were iv administered with Thymopentin Injection on the basis of routine treatment, 10 mg added into 0.9% Sodium Chloride Injection 2 mL, once daily, for 7 d. The clinical efficacy and prognosis time of the two groups were observed, and the changes of immune function indexes, inflammatory factors indexes, pulmonary function indexes and arterial blood gas indexes were compared between two groups before and after treatment. Results After treatment, the total effective rate in the treatment group was 97.14%, significantly higher than that in the control group(80.00%, P < 0.05). After treatment, the time of shock reversal, mechanical ventilation and hospitalization in the treatment group were significantly shorter than those in the control group(P < 0.05). After treatment, CD3+ and CD4+/CD8+ in two groups were significantly increased compared with before treatment, but procalcitonin(PCT), interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α) were significantly decreased(P < 0.05). After treatment, the improvement of immune function and inflammatory factors in treatment group was better than that in control group(P < 0.05). After treatment, forced respiration volume in one second(FEV1), FEV1 to vital capacity ratio(FEV1/FVC), and arterial partial pressure of oxygen(pO2) were significantly increased in both groups, while arterial partial pressure of carbon dioxide(pCO2) was significantly decreased(P < 0.05). After treatment, the improvement of pulmonary function indexes and arterial blood gas indexes in treatment group was better than that in control group(P < 0.05). Conclusion Thymopentin in treatment of severe pneumonia complicated with sepsis can improve the immune function of patients, and can reduce the inflammatory response, pulmonary ventilation disorder, and arterial blood gas disorder, so as to reverse the shock state of patients as soon as possible, shorten the length of hospital stay, which has fewer adverse reactions with safety and reliance.