亚胺培南联合连续性血液净化治疗脓毒症致急性呼吸窘迫综合征的疗效及安全性分析  

Efficacy and safety analyses of Imipenem combined with continuous blood purification in treatment of acute respiratory distress syndrome caused by sepsis

作　　者：杨云 林森[1] 宫保强 刘畅 邓武兴 Yang Yun;Lin Sen;Gong Baoqiang;Liu Chang;Deng Wuxing(Department of Critical Care Medicine,Sanya Centred Hospital(The Third People's Hospital of Hainan Province),Sanya 572000,Hainan,China)

机构地区：[1]三亚中心医院(海南省第三人民医院)重症医学科,海南三亚572000

出　　处：《中国中西医结合急救杂志》2021年第1期31-34,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：海南省卫生计生行业科研项目(19A200150)。

摘　　要：目的研究亚胺培南联合连续性血液净化(CBP)治疗脓毒症致急性呼吸窘迫综合征(ARDS)的临床疗效及安全性.方法选择2017年4月至2020年4月三亚中心医院重症监护病房(ICU)收治的114例脓毒症致ARDS患者作为研究对象,根据治疗方法不同分为研究组和对照组,每组57例.两组均给予CBP,研究组加用亚胺培南-西司他丁钠(0.25~1.00 g静脉滴注,每日1次).比较两组治疗前后凝血功能指标〔纤维蛋白原(FIB)、D-二聚体、血小板计数(PLT)、凝血酶时间(TT)〕、血清炎性因子〔降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)〕以及临床疗效、治疗后改良Marshall评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、ICU住院时间、病死率.结果治疗后两组FIB、D-二聚体、TT及血清PCT、hs-CRP、TNF-α水平均较治疗前降低,且研究组均明显低于对照组〔FIB(g/L):3.64±0.65比6.25±0.92,D-二聚体(μg/L):304.22±64.12比403.15±92.51,TT(s):15.32±2.82比20.12±3.62,PCT(ng/L):4.06±0.84比9.26±1.23,hs-CRP(mg/L):6.35±0.71比12.43±5.56,TNF-α(g/L):24.31±3.22比41.27±4.43,均P<0.05〕,PLT较治疗前升高,且研究组明显高于对照组(×10^(9)/L:25.46±4.73比14.24±1.44,P<0.05).研究组临床治疗总有效率明显高于对照组〔94.74%(54/57)比71.93%(41/57),P<0.05〕,治疗后改良Marshall评分(分:5.18±1.06比12.47±3.84)、APACHEⅡ评分(分:6.34±1.22比13.28±4.07)和病死率〔26.32%(15/57)比42.11%(24/57)〕均明显低于对照组(均P<0.05),ICU住院时间较对照组明显缩短(d:7.27±2.04比13.17±3.05,P<0.05).结论亚胺培南联合CBP治疗脓毒症致ARDS的疗效确切,可有效改善患者凝血功能指标,降低体内炎症反应,降低病死率.Objective To investigate the clinical efficacy and safety of imipenem combined with continuous blood purification(CBP)in the treatment of acute respiratory distress syndrome(ARDS)caused by sepsis.Methods 114 patients with ARDS caused by sepsis admitted to the intensive care unit(ICU)of Sanya Central Hospital from April 2017 to April 2020 were selected as research subjects and were divided into a study group and a control group,with 57 cases in each group.The two groups were treated with CBP,and additionally the patients in the study group were given Imipenem-Cilastatin sodium(0.25-1.00 g by intravenous drip,once a day)for treatment.The coagulation function indexes[fibrinogen(FIB),D-dimer,platelet count(PLT)and thrombin time(IT)],serum inflammatory factors[procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP)and tumor necrosis factor-α(TNF-α)]before and after treatment,and clinical efficacy,modified Marshall score,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score after treatment,length of ICU stay and mortality were compared behveen the two groups.Results After treatment,the FIB,D-dimer,TT,serum PCT,hs-CRP,and TNF-α levels of the two groups were decreased,and the levels of study group were significantly lower than those in the control group[FIB(g/L):3.64±0.65 vs.6.25±0.92,D-dimer Qig/L):304.22±64.12 vs.403.15±92.51,TT(s):15.32±2.82 vs.20.12±3.62,PCT(ng/L):4.06±0.84 vs.9.26±1.23,hs-CRP(mg/L):6.35±0.71 vs.12.43±5.56,TNF-α(g/L):24.31±3.22 vs.41.27±4.43,all P<0.05];the PLT level was increased compared with that before treatment,and the level of study group was significantly higher than that in the control group(×10^(9)/L:25.46±4.73 vs.14.24±1.44,P<0.05).The total clinical effective rate in the study group was obviously higher than that in the control group[94.74%(54/57)vs.71.93%(41/57),P<0.05].After treatment,the modified Marshall score(5.18±1.06 vs.12.47±3.84),APACHE Ⅱ score(6.34±1.22 vs.13.28±4.07)and mortality[26.32%(15/57)vs.42.11%(24/57)]in study group were signifi

关 键 词：亚胺培南 连续性血液净化 脓毒症 急性呼吸窘迫综合征 

分 类 号：R47[医药卫生—护理学]