血必净注射液对呼吸机相关性肺炎患者炎症指标及预后的影响

Effect of Xuebijing injection on inflammation indexes and prognosis of patients with ventilator-associated pneumonia

目的探讨血必净注射液对呼吸机相关性肺炎(VAP)患者炎症级联反应以及预后因素的影响。方法采用前瞻性研究方法,以2018年7月至2019年7月福建中医药大学附属第三人民医院重症医学科收治的70例VAP患者为研究对象。随机将入组患者分为治疗组(n=37)和对照组(n=33),两组均参照中国HAP/VAP指南进行综合治疗,治疗组加用血必净注射液(100 mL,Bid),疗程7 d,分别于治疗前及治疗3、7、10 d记录两组APACHEⅡ评分、SOFA评分,检测WBC、CRP、PCT及IL-6水平,并统计机械通气时间、入住ICU时间及28 d死亡率。比较组间差异,分析与预后相关的因素。结果①治疗7 d时,治疗组WBC、IL-6较对照组降低,治疗10 d时治疗组WBC、CRP、PCT、IL-6均明显降低(P<0.05)。②治疗组可明显缩短机械通气时间及入住ICU时间(P<0.05),但28 d死亡率组间比较无统计学差异(P>0.05)。③IL-6及APACHEⅡ评分是影响VAP患者预后的独立危险因素(P<0.05)。结论血必净注射液能够减轻VAP患者的炎症反应,缩短机械通气时间及入住ICU时间,但并不能降低VAP患者28 d死亡率。

Objective To explore the effect of Xuebijing injection on inflammatory cascade reaction and prognostic factors in patients with ventilator-associated pneumonia(VAP).Methods A prospective study was conducted on 70 VAP patients admitted to the Department of Critical Care Medicine of the Third Affiliated People′s Hospital of Fujian University of Traditional Chinese Medicine from July 2018 to July 2019 selected as research objects.Patients were randomly divided into the treatment group(n=37)and the control group(n=33).Both groups were given comprehensive treatment according to Chinese HAP/VAP guidelines.The treatment group was given Xuebijing injection(100 mL,Bid)for 7 days.APACHEⅡscore and SOFA score were recorded before treatment and on the 3^(rd),7^(th) and 10^(th) day of treatment,respectively,and levels of White Blood Cell Count(WBC),C-reactive protein(CRP),procalcitonin(PCT)and Interleukin-6(IL-6)were detected.The mechanical ventilation time,duration in ICU and 28-day mortality was counted.The differences between groups were compared and the factors related to prognosis were analyzed.Results①The WBC and IL-6 in the treatment group were lower than those in the control group on the 7^(th) day of treatment,while the WBC,CRP,PCT and IL-6 in the treatment group were significantly lower on the 10^(th) day of treatment(P<0.05).②The treatment group can obviously shorten the time of mechanical ventilation and the duration in ICU(P<0.05),but there was no statistically significant difference in 28-day mortality(P>0.05).③IL-6 and APACHEⅡscores were independent risk factors affecting the prognosis of VAP patients(P<0.05).Conclusion Xuebijing injection can alleviate the inflammatory reaction of VAP patients,shorten the time of mechanical ventilation and duration in ICU,but it can′t reduce the 28-day mortality of VAP patients.