哌拉西林/他唑巴坦治疗脓毒症的疗效  

Effect of piperacillin / tazobactam on treatment of patients with sepsis

作　　者：周大鹏[1] 陈贵艳[2] 周景霞[1] 刘春涛[1] 武会志 ZHOU Da-peng;CHEN Gut-yan;ZHOU Jing-xia;LIU Chun-tao;WU Hui-zhi(Chengde Central Hospital,Chengde,Hebei 067000,China)

机构地区：[1]承德市中心医院重症医学科,河北承德067000 [2]承德市中心医院感染性疾病科,河北承德067000

出　　处：《中华医院感染学杂志》2019年第23期3553-3557,共5页Chinese Journal of Nosocomiology

基　　金：河北省科技计划基金资助项目(201704B003)

摘　　要：目的探讨哌拉西林/他唑巴坦对脓毒症患者血清高迁移率族蛋白B1(High mobility group protein B1,HMGB1)、生长抑制特异性基因6(growth arrest-specific gene,Gas6)、可溶性髓系细胞触发受体-1(soluble Triggering Receptor Expressed on Myeloid Cells-1,sTREM-1)表达及预后的影响。方法选择承德市中心医院于2016年6月-2018年6月收治的脓毒症患者82例,按照随机数字表法分为对照组41例与试验组41例。对照组行液体复苏、抗感染、血管活性药物、糖皮质激素、抗凝治疗、肾脏替代治疗及机械通气等常规治疗;试验组在对照组基础上经验性应用哌拉西林/他唑巴坦。比较两组患者疗效,治疗前后肺损伤评分(Murray评分)、急性生理与慢性状况评分系统(Acute physiology and chronic health evaluation scoring system II,APACHE II)评分、序贯器官功能障碍评分(Sequential organ dysfunction score,SOFA)、HMGB1、Gas6、sTREM-1、C反应蛋白(C-reactive protein,CRP)和降钙素原(Procalcitonin,PCT)水平变化,及预后情况。结果治疗后,试验组患者总有效率为97.56%,高于对照组的80.49%(P<0.05);试验组患者Murray评分(1.49±0.27)分、APACHE II评分(8.39±1.08)分和SOFA评分(4.09±0.76)分,均低于对照组的(2.08±0.38)分、(12.64±2.16)分和(5.89±1.09)分(P<0.05);试验组患者血清HMGB1(54.32±7.82)μg/L和Gas6(20.38±2.46)ng/ml,均低于对照组(78.18±10.29)μg/L和(26.57±4.10)ng/ml(P<0.05);试验组患者血清sTREM-1(24.35±8.79)pg/ml、CRP(6.71±1.87)mg/L和PCT(2.63±0.46)mg/L,均低于对照组(37.81±5.42)pg/mL、(19.98±2.06)mg/L和(3.87±0.71)mg/L。结论哌拉西林/他唑巴坦对脓毒症患者疗效良好,可降低血清HMGB1、Gas6、sTREM-1、CRP和PCT水平,且预后良好,值得借鉴。OBJECTIVE To investigate the effect of piperacillin/tazobactam on the expression of serum high mobility group protein B1(HMGB1),growth inhibition specific gene 6(Gas6),soluble trigger receptor-1(sTREM-1)in patients with sepsis and prognosis of the disease.METHODS The total of 82 patients with sepsis admitted to Chengde Central Hospital,from June 2016 to June 2018 were recuited in the control group(41 cases)and the observation group(41 cases).Routine treatment of fluid resuscitation,anti-infection,vasoactive drugs,glucocorticoids,anticoagulation therapy,renal replacement therapy and mechanical ventilation were performed in the control group.Besides of the routine treatment,the observation group was empirically given the medication of piperacillin and tazobactam.The therapeutic effects,pulmonary injury score(Murray score),APACHE II score,sequential organ dysfunction score(SOFA),levels of HMGB1,Gas6,sTREM-1,C-reactive protein(CRP)and procalcitonin(PCT)before and after the treatment were compared between the two groups,and prognosis of the disease was evaluated.RESULTS The total effective rate in the experimental group(97.56%)was significantly higher than that in the control group(80.49%)(P<0.05).Murray score(1.49±0.27),APACHE II score(8.39±1.08)and SOFA score(4.09±0.76)in the experimental group after treatment were significantly lower than that in the control group(P<0.05),which was(2.08±0.38),(12.64±2.16)and(5.89±1.09),respectively.After the treatment,levels of serum HMGB1(54.32±7.82)ug/L and Gas6(20.38±2.46)ng/ml in the experimental group were significantly lower(P<0.05)than that in the control group,with the concentration of(78.18±10.29)ug/L and(26.57±4.10)ng/ml.Levels of serum sTREM-1(24.35±8.79)pg/ml,CRP(6.71±1.87)mg/L and PCT(2.63±0.46)mg/L in the experimental group were lower than that in the control group with the content of(37.81±5.42)pg/ml,(19.98±2.06)mg/L and(3.87±0.71)mg/L,respectively.CONCLUSION Medical treatment of Piperacillin and tazobactam had a good effect on sepsis patients by redu

关 键 词：哌拉西林/他唑巴坦 脓毒症 高迁移率族蛋白B1 生长抑制特异性基因6 可溶性髓系细胞触发受体-1 预后 

分 类 号：R631.1[医药卫生—外科学]