亚胺培南联合氨溴索治疗重症肺炎的疗效及对炎症因子的影响观察

Effect of Imipenem Combined with Ambroxol on Severe Pneumonia and its Effect on Inflammatory Factors

目的探讨亚胺培南联合氨溴索治疗重症肺炎的疗效及对炎症因子的影响。方法选择2020年9月至2022年9月南阳市中心医院ICU收治的92例重症肺炎患者为研究样本,组别划分依据为随机数字表法,常规组划入46例,同时接受氨溴索及莫西沙星联合治疗,研究组划入46例,使用氨溴索及亚胺培南联合治疗。两组均持续治疗2周,均给予吸氧,调节酸碱平衡,营养支持等常规对症治疗。评价两组治疗的有效性,比较两组治疗后各项体征恢复时间及治疗前后炎症因子水平[降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、IL-6白细胞介素6(IL-6)],观察两组用药前后的动脉血气分析指标及免疫功能变化,评价两组治疗的安全性。结果研究组治疗有效率(93.48%)高于常规组(80.43%),差异有统计学意义(P<0.05)。研究组退热时间、机械通气时间、肺部X线阴影消失时间均短于常规组,ICU住院时间比常规组短,病灶吸收率比常规组更高,差异有统计学意义(P<0.05)。治疗前,两组炎症因子水平比较,差异无统计学意义(P>0.05);治疗后,研究组PCT、hs-CRP、IL-6水平均低于常规组,差异有统计学意义(P<0.05)。治疗前,两组PaO_(2)、PaCO_(2)、PAP血气分析指标比较,差异无统计学意义(P>0.05);治疗后,研究组PaO_(2)水平高于常规组,PaCO_(2)、PAP水平低于常规组,差异有统计学意义(P<0.05)。治疗前,两组T淋巴细胞亚群各指标比较,差异无统计学意义(P>0.05);治疗后,研究组的CD3^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)值均高于常规组,CD8^(+)水平低于常规组,差异有统计学意义(P<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论在常规对症治疗的基础上采用亚胺培南联合氨溴索治疗效果显著,有利于降低重症肺炎患者机体的炎症因子水平,改善动脉血气分析指标与免疫功能,进一步提高患者的临床治疗效果,保障治疗安全性,临床应用价值显著。

Objective To investigate the efficacy of imipenem combined with ambroxol in the treatment of severe pneumonia and its effect on inflammatory factors.Methods A total of 92 patients with severe pneumonia admitted to the ICU of Nanyang Central Hospital from September 2020 to September 2022 were selected as study samples.The groups were divided according to the random number table method.The 46 patients in the conventional group were assigned to receive the combined treatment of ambroxol and moxifloxacin,and 46 patients in the study group were assigned to receive the combined treatment of ambroxol and imipenem.Both groups received continuous treatment for 2 weeks and were given conventional symptomatic treatment such as oxygen inhalation,acid-base balance adjustment,and nutritional support.To evaluate the efficacy of treatment in the two groups,the recovery time of various signs after treatment and the levels of inflammatory factors before and after treatment[procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),IL-6 interleukin-6(IL-6)]were compared between the two groups,the changes of arterial blood gas analysis indexes and immune function before and after treatment were observed in the two groups,and the safety of treatment was evaluated.Results The effective rate of the study group(93.48%)was higher than that of the conventional group(80.43%),the difference was statistically significant(P<0.05).The anti-pyrexia time,mechanical ventilation time,and lung X-ray shadow disappearance time of the study group were shorter than those of the conventional group,the ICU hospitalization time was shorter than that of the conventional group,and the lesion absorption rate was higher than that of the conventional group,and the differences were statistically significant(P<0.05).Before treatment,there was no significant difference in the levels of inflammatory factors between the two groups(P>0.05).After treatment,the levels of PCT,hs-CRP,and IL-6 in the study group were lower than those in the conventional group,and the difference was statistically significant(P<0.05).Before treatment,there was no significant difference in blood gas analysis indexes of PaO_(2),PaCO_(2),and PAP between the two groups(P>0.05).After treatment,PaO_(2) levels in the study group were higher than those in the conventional group,while PaCO_(2) and PAP levels were lower than those in the conventional group,with statistical significance(P<0.05).Before treatment,there was no significant difference in T lymphocyte subsets between the two groups(P>0.05).After treatment,the levels of CD3^(+),CD4^(+),and CD4^(+)/CD8^(+)in the study group were higher than those in the conventional group,while the level of CD8^(+)was lower than that in the conventional group,with statistical significance(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion On the basis of conventional symptomatic treatment,imipenem combined with ambroxol can significantly reduce the level of inflammatory factors in patients with severe pneumonia, improve the index of arterial blood gas analysis and immune function, further improve the clinical effect of patients, ensure the safety of treatment, and have significant clinical application value.