抗生素降阶梯治疗糖尿病合并重症肺炎的临床效果

Clinical effect of antibiotic step-down therapy in the treatment of diabetes with severe pneumonia

目的观察抗生素降阶梯治疗糖尿病合并重症肺炎的临床效果。方法选择2018年1月-2019年12月内蒙古自治区霍林郭勒市人民医院收治的糖尿病合并重症肺炎患者60例,采取随机数字表法分为观察组和对照组,每组30例。对照组采取常规抗生素治疗方案,观察组采取抗生素降阶梯治疗方案。比较2组的临床疗效、症状缓解时间、抗生素使用时间、住院时间、治疗前后血清炎性因子指标、肺通气功能指标、动脉血气指标及不良反应。结果观察组总有效率为93.33%,高于对照组的73.33%(χ^(2)=4.320,P=0.038)。观察组咳嗽、发热症状缓解时间、抗生素使用时间、住院时间均短于对照组(P<0.01)。2组治疗后血清白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)水平均低于治疗前,且观察组低于对照组(P<0.01)。2组治疗后第1秒用力呼吸容积(FEV_(1))、FEV_(1)与肺活量比值(FEV_(1)/FVC)、动脉血氧分压(PaO_(2))、血氧饱和度(Sp O_(2))均高于治疗前,动脉血二氧化碳分压(PaCO_(2))低于治疗前,且观察组变化幅度大于对照组(P<0.01)。2组不良反应总发生率比较差异无统计学意义(6.67%vs.10.00%,χ^(2)=0.218,P=0.640)。结论抗生素降阶梯治疗糖尿病合并重症肺炎具有良好的临床疗效,可加快症状缓解,缩短抗生素使用时间,减轻炎性反应,改善肺通气功能和动脉血气状况,且不会增加不良反应,安全性良好。

Objective To observe the clinical effect of antibiotic ladder-down therapy in the treatment of diabetes mellitus complicated with severe pneumonia.Methods From January 2018 to December 2019,60 patients with diabetes and severe pneumonia admitted to the Huo Lin Guo Le City People’s Hospital in Inner Mongolia Autonomous Region were selected and divided into observation group and control group by random number table method,with 30 cases in each group.The control group took the conventional antibiotic treatment plan,and the observation group took the antibiotic de-escalation treatment plan.The clinical efficacy,symptom relief time,antibiotic use time,hospitalization time,serum inflammatory factors,pulmonary ventilation function,arterial blood gas before and after treatment and adverse reactions were compared between the two groups.Results The total effective rate in the observation group was 93.33%,which was higher than 73.33%in the control group(χ^(2)=4.320,P=0.038).The time to relieve cough and fever symptoms,antibiotic use time,and hospital stay in the observation group were shorter than those in the control group(P<0.01).The serum white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)levels after treatment in the two groups were lower than those before treatment,and the observation group was lower than the control group(P<0.01).The forced breathing volume in the first second after treatment(FEV_(1)),ratio of FEV_(1) to vital capacity(FEV_(1)/FVC),arterial oxygen partial pressure(PaO_(2)),blood oxygen saturation(SpO_(2))were higher than before treatment,and the partial pressure of arterial carbon dioxide(PaCO_(2))was lower than before treatment,and the variation range of the observation group was greater than that of the control group(P<0.01).There was no significant difference in the total incidence of adverse reactions between the two groups(6.67%vs.10.00%,χ^(2)=0.218,P=0.640).Conclusion Antibiotic step-down therapy has a good clinical effect in patients with diabetes complicated with severe pneumonia.It can accelerate symptom relief,reduce antibiotic use time,reduce inflammatory reaction,improve lung ventilation function and arterial blood gas status,and has good safety without increasing adverse reactions.