探讨头孢他啶联合盐酸溴己新治疗慢性阻塞性肺疾病合并肺部感染的临床疗效

Clinical efficacy of ceftazidime combined with bromhexine hydrochloride in the treatment of chronic obstructive pulmonary disease with pulmonary infection

目的分析头孢他啶联合盐酸溴己新治疗慢性阻塞性肺疾病合并肺部感染的临床疗效以及其对肺功能、炎性因子的影响。方法72例慢性阻塞性肺疾病合并肺部感染患者,用信封抽签方法分为治疗组和对照组,每组36例。对照组给予头孢他啶治疗,治疗组给予头孢他啶联合盐酸溴己新治疗。比较两组患者治疗前后炎性因子[降钙素原(PCT)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平、症状(咳嗽、发热、肺部啰音)改善时间、血气指标[氧合指数(OI)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、肺功能指标[呼气峰值流量(PEF)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)]、临床疗效。结果治疗后,治疗组患者PCT(0.47±0.19)ng/ml、hs-CRP(9.28±1.17)mg/L、TNF-α(5.15±1.86)pg/ml、IL-6(22.16±2.19)pg/ml,与对照组的(0.70±0.26)ng/ml、(13.04±1.36)mg/L、(8.28±2.11)pg/ml、(29.32±3.78)pg/ml比较,差异有统计学意义(t=4.285、12.575、6.677、9.834,P<0.05)。治疗后,治疗组患者咳嗽改善时间(3.94±1.45)d、发热改善时间(3.08±0.79)d、肺部啰音改善时间(5.34±1.46)d,与对照组的(6.18±2.24)、(6.18±1.72)、(7.82±2.17)d比较,差异有统计学意义(t=5.037、9.827、5.689,P<0.05)。治疗后,治疗组患者OI(293.49±20.04)mm Hg(1 mm Hg=0.133 kPa)、PaO_(2)(86.36±7.72)mm Hg较对照组的(267.25±15.92)、(78.52±5.57)mm Hg更高,PaCO_(2)(30.12±3.23)mm Hg较对照组的(35.49±4.35)mm Hg更低,差异有统计学意义(P<0.05)。治疗后,治疗组患者PEF(5.94±0.58)L/s、FVC(2.91±0.34)L、FEV1(2.31±0.27)L,均高于对照组的(5.09±0.54)L/s、(2.44±0.31)L、(1.70±0.23)L,差异有统计学意义(t=6.436、6.129、10.319,P<0.05)。治疗组临床总有效率94.44%高于对照组的75.00%,差异有统计学意义(χ2=5.258,P<0.05)。结论头孢他啶联合盐酸溴己新治疗慢性阻塞性肺疾病合并肺部感染可以促进患者的肺功能、炎性因子水平显著改善,提高临床疗效,是值得应用的治疗方案。

Objective To analyze the clinical efficacy of ceftazidime combined with bromhexine hydrochloride in the treatment of chronic obstructive pulmonary disease with pulmonary infection,and its impact on lung function and inflammatory factors.Methods 72 patients with chronic obstructive pulmonary disease complicated with pulmonary infection were divided into a treatment group and a control group by envelope drawing method.The control group was treated with ceftazidime,while the treatment group was treated with ceftazidime combined with bromhexine hydrochloride.Patients in both groups were compared in terms of inflammatory factors[procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],time of symptom(cough,fever and lung rale)improvement,blood gas indicators[oxygenation index(OI),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],lung function indicators[peak expiratory flow(PEF),forced vital capacity(FVC),and forced expiratory volume in one second(FEV1)],and clinical efficacy.Results After treatment,the treatment group had PCT of(0.47±0.19)ng/ml,hs-CRP of(9.28±1.17)mg/L,TNF-αof(5.15±1.86)pg/ml,and IL-6 of(22.16±2.19)pg/ml,which were statistically different from(0.70±0.26)ng/ml,(13.04±1.36)mg/L,(8.28±2.11)pg/ml,and(29.32±3.78)pg/ml in the control group(t=4.285,12.575,6.677,9.834;P<0.05).After treatment,the improvement time of cough,fever and lung rale in the treatment group were(3.94±1.45),(3.08±0.79)and(5.34±1.46)d,which were statistically different from(6.18±2.24),(6.18±1.72)and(7.82±2.17)d in the control group(t=5.037,9.827,5.689;P<0.05).After treatment,the treatment group had OI of(293.49±20.04)mm Hg(1 mm Hg=0.133 kPa)and PaO_(2) of(86.36±7.72)mm Hg,which were higher than(267.25±15.92)and(78.52±5.57)mm Hg in the control group;the treatment group had lower PaCO_(2) of(30.12±3.23)mm Hg than(35.49±4.35)mm Hg in the control group.The difference was statistically significant(P<0.05).After treatment,the treatment group had PEF of(5.94±0.58)L/s,FVC of(2.91±0.34)L and FEV1 of(2.31±0.27)L,which were higher than(5.09±0.54)L/s,(2.44±0.31)L and(1.70±0.23)L in the control group.The difference was statistically significant(t=6.436,6.129,10.319;P<0.05).The total clinical effective rate of the treatment group was 94.44%,which was higher than 75.00%of the control group,and the difference was statistically significant(χ2=5.258,P<0.05).Conclusion The combination of ceftazidime and bromhexine hydrochloride in the treatment of chronic obstructive pulmonary disease with pulmonary infection can promote lung function,significantly improve inflammatory factor levels,and enhance clinical efficacy.It is a worthwhile treatment plan to be applied.