头孢曲松联合糖皮质激素对老年重症肺炎患者呼吸道纤毛清除功能及微炎症因素的影响

Effect of ceftriaxone combined with glucocorticoids on ciliary clearance function and micro-inflammatory factors in elderly patients with severe pneumonia

目的探讨头孢曲松联合糖皮质激素对重症肺炎患者呼吸道纤毛清除功能及微炎症因素的影响。方法选取2022年5月至2023年10月泸州市中医医院治疗的老年重症肺炎共110例患者为此次试验对象,按照随机数表法分成两组,对照组55例患者给予头孢曲松治疗,研究组55例患者则在对照组基础上联合糖皮质激素治疗。比较两组的临床疗效,呼吸道纤毛清除功能、微炎症状态、血气分析指标以及不良反应发生率。结果研究组治疗总有效率(94.55%)相较于对照组(76.36%)更高(χ^(2)=7.314,P=0.007)。治疗后对照组和研究组鼻黏膜纤毛清除率、鼻黏膜纤毛清除速度、鼻黏膜纤毛传输速度、转化生长因子-β水平、动脉血氧分压水平[分别为(68.12±4.78)%、(76.23±4.56)%,(6.54±0.24)mm·min^(-1)、(7.23±0.21)mm·min^(-1),(9.23±2.06)mm·min^(-1)、(11.18±2.26)mm·min^(-1),(259.52±45.72)pg·mL^(-1)、(279.62±40.42)pg·mL^(-1),(81.42±10.39)mm Hg(1 mm Hg≈0.133 kPa)、(86.59±9.24)mm Hg]均高于治疗前[分别为(44.74±3.97)%、(44.62±4.01)%,(3.42±0.31)mm·min^(-1)、(3.37±0.36)mm·min^(-1),(6.40±0.16)mm·min^(-1)、(6.35±0.24)mm·min^(-1),(174.29±28.36)pg·mL^(-1)、(166.79±26.84)pg·mL^(-1),(60.43±6.89)mm Hg、(60.08±6.47)mm Hg],且研究组高于对照组,差异有统计学意义(t=9.104、16.046、4.617、2.443、2.758,均P<0.05)。治疗后对照组和研究组C反应蛋白、降钙素原水平、动脉血二氧化碳分压水平[分别为(25.48±3.42)mg·L^(-1)、(19.28±2.69)mg·L^(-1),(2.39±0.45)ng·mL^(-1)、(1.45±0.39)ng·mL^(-1),(41.48±6.39)mm Hg、(38.39±5.89)mm Hg]均低于治疗前[分别为(52.25±7.46)mg·L^(-1)、(51.72±7.01)mg·L^(-1),(7.01±1.39)ng·mL^(-1)、(7.19±1.31)ng·mL^(-1),(56.13±7.23)mm Hg、(55.68±8.11)mm Hg],且研究组低于对照组,差异有统计学意义(t=10.567、11.707、2.637,均P<0.05)。在不良反应发生率方面,研究组(12.73%)和对照组(9.09%)相比,差异无统计学意义(χ^(2)=0.374,P=0.541)。结论头孢曲松联合糖皮质激素治疗重症肺炎的疗效较好,可改善患者呼吸道纤毛清除功能及微炎症状态,优化血气分析指标。

Objective To investigate the effect of ceftriaxone combined with glucocorticoids on mucociliary clearance and microinflammatory state in elderly patients with severe pneumonia.Methods A total of 110 elderly patients with severe pneumonia treated in Luzhou Hospital of Traditional Chinese Medicine from May 2022 to October 2023 were prospectively selected as the subjects of this trial.They were randomly divided into two groups using a random number table method.The control group of 55 patients received treatment with ceftriaxone,while the study group of 55 patients received treatment with glucocorticoids in addition to the regimen in the control.The clinical efficacy,respiratory tract cilia clearance function,microinflammatory state,blood gas indicators and adverse reaction rate were compared between the two groups.Results The total effective rate of the treatment group was significantly higher than that of the control(94.55%vs 76.36%,χ^(2)=7.314,P=0.007).After treatment,the nasal mucociliary clearance rate,nasal mucociliary clearance speed,nasal mucociliary transport speed,transforming growth factor-βlevel,and arterial blood oxygen partial pressure level were(68.12±4.78,76.23±4.56)%,(6.54±0.24,7.23±0.21)mm·min^(-1),(9.23±2.06,11.18±2.26)mm·min^(-1),(259.52±45.72,279.62±40.42)pg·mL^(-1),(81.42±10.39,86.59±9.24)mm Hg(1 mm Hg≈0.133 kPa),respectively.They were higher than those before treatment((44.74±3.97,44.62±4.01)%,(3.42±0.31,3.37±0.36)mm·min^(-1),(6.40±0.16,6.35±0.24)mm·min^(-1),(174.29±28.36,166.79±26.84)pg·mL^(-1),(60.43±6.89,60.08±6.47)mm Hg).Meanwhile,these indexes were higher in the observation group than in the control,showing statistical obvious differences(t=9.104,16.046,4.617,2.443,2.758,all P<0.05).The levels of C-reactive protein,procalcitonin and arterial partial pressure of carbon dioxide in the observation group were(25.48±3.42,19.28±2.69)mg·L^(-1),(2.39±0.45,1.45±0.39)ng·mL^(-1),(41.48±6.39,38.39±5.89)mm Hg,respectively,and they were lower than those of(52.25±7.46,51.72±7.01)mg·L^(-1),(7.01±1.39,7.19±1.31)ng·mL^(-1),(56.13±7.23,55.68±8.11)mm Hg in the control and the difference was statistically obvious(t=10.567,11.707,2.637,all P<0.05).There was no significant difference in the incidence of adverse reactions between the observation group(12.73%)and the control group(9.09%)(χ^(2)=0.374,P=0.541).Conclusion Ceftriaxone combined with glucocorticoids is effective in the treatment of severe pneumonia because it can improve the cilia clearance function of respiratory tract and micro inflammatory state and optimize blood gas indexes.