头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎的临床应用研究

Clinical application of cefoperazone/sulbactam combined with thymosin α1 for the treatment of severe pneumonia caused by Acinetobacter baumannii

摘要:

目的观察头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎的临床疗效及预后评估。方法随机选取84例临床诊断为鲍曼不动杆菌感染致重症肺炎的患者，分为治疗组（应用头孢哌酮/舒巴坦联合胸腺肽α1进行治疗）和对照组（单用头孢哌酮/舒巴坦进行治疗），各42例，比较两组患者治疗前和治疗7 d后降钙素原（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）、外周血T细胞亚群、白细胞介素6（IL6）、白细胞介素10（IL10）、免疫球蛋IgG和APACHE Ⅱ评分,同时观察脱机成功率、住ICU时间和28 d病死率。结果治疗7 d后治疗组与对照组相比，CD4+T细胞、CD4+／CD8+、IL10和IgG均明显升高，差异有统计学意义(均P＜0.05)；同时PCT、CRP、WBC、IL6和APACHE Ⅱ评分均明显下降，差异均有统计学意义(均P＜0.05)。治疗组脱机成功率高于对照组（64.29% vs 38.10%），平均住ICU时间短于对照组［（12.41±2.25）d vs （18.23±2.50）d］，28 d病死率低于对照组（19.05% vs 45.24%），差异均有统计学意义(均P＜0.05)。结论头孢哌酮/舒巴坦联合胸腺肽α1治疗鲍曼不动杆菌重症肺炎可以改善患者机体的免疫功能，减轻炎症反应，提高呼吸机脱机成功率，缩短ICU住院时间，降低28 d病死率。

Abstract:

ObjectiveTo evaluate the clinical efficacy and prognosis of cefoperazone/sulbactam combined with thymosin α1 in the treatment of severe pneumonia caused by  Acinetobacter baumannii(A. baumannii ). Methods84 patients with severe pneumonia caused by  A. baumannii  were randomly selected, they were divided into treatment group(n=42, cefoperazone/sulbactam combined with thymosin α1 treatment) and control group(n=42, only cefoperazone/ sulbactam treatment). Procalcitonin（PCT）, Creactive protein（CRP）, white blood cell（WBC）count, peripheral blood T lymphocyte subsets, interleukin6（IL6）, interleukin10（IL10）, immunoglobulin G (IgG), and APACHE II score of two groups before treatment and 7 days after treatment were compared, ventilator weaning success rate, length of ICU stay, and 28day mortality were also observed. ResultsAfter 7 day treatment, compared with the control group, CD4+T cells, CD4+／CD8+, IL10, and IgG in the treatment group were all significantly higher (all P<0.05); PCT, CRP, WBC, IL6, and APACHE II score all significantly declined, difference were all significant(all P<0.05). Ventilator weaning success rate in treatment group was higher than control group（64.29% vs 38.10%），mean length of ICU stay was shorter than control group（［12.41±2.25］d vs［18.23±2.50］d），28day mortality was lower than control group（19.05% vs 45.24%）, difference were all significant(all P<0.05). ConclusionCefoperazone/sulbactam combined with thymosin α1 for the treatment of severe pneumonia caused by  A. baumannii  can improve the immune function of patients, reduce inflammation, increase ventilator weaning success rate, shorten ICU stay， and decrease 28day mortality.