抗生素降阶梯疗法对老年重症肺炎患者免疫失衡、临床疗效及安全性的影响  

Effect of Antibiotic De-escalation Therapy on Immune Imbalance,Clinical Effect and Safety in Elderly Patients with Severe Pneumonia

作　　者：柳彦涛[1] 张艳艳 李叶宁[1] 徐欢欢[1] LIU Yan-tao;ZHANG Yan-yan;LI Ye-ning;XU Huan-huan(Department of Critical Care Medicine,Luohe Central Hospital,Luohe 462300,China)

机构地区：[1]漯河市中心医院重症医学科,漯河462300

出　　处：《中国合理用药探索》2021年第11期57-61,共5页Chinese Journal of Rational Drug Use

摘　　要：目的:探讨抗生素降阶梯疗法对老年重症肺炎患者免疫失衡、临床疗效及安全性的影响。方法:回顾性分析2017年9月~2020年9月本院收治的96例老年重症肺炎患者临床资料,根据抗生素治疗方法,分为对照组(n=56)和研究组(n=40)。对照组采用常规抗生素疗法进行治疗,研究组采用抗生素降阶梯疗法进行治疗。比较两组临床疗效,治疗前和治疗后指端血氧饱和度、血浆降钙素原(PCT)水平、血清白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平及T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))计数水平,并计算CD4^(+)/CD8^(+)比值。记录两组静脉应用抗生素时间、感染控制时间、住院时间、体温恢复正常时间、咳嗽缓解时间、白细胞总数恢复正常时间等转归指标以及不良反应发生情况。结果:研究组总有效率(95.00%)高于对照组(80.36%,P<0.05)。治疗后,两组指端血氧饱和度、CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)高于治疗前,血浆PCT水平、血清IL-6和TNF-α水平以及CD8^(+)低于治疗前,且研究组指端血氧饱和度、CD3^(+)、CD4^(+)和CD4^(+)/CD8^(+)高于对照组,血浆PCT水平、血清IL-6和TNF-α水平以及CD8^(+)低于对照组(P<0.05)。研究组静脉应用抗生素时间、感染控制时间、住院时间、体温恢复正常时间、咳嗽缓解时间、白细胞总数恢复正常时间短于对照组(P<0.05)。治疗期间,两组不良反应总发生率比较无统计学差异(P>0.05)。结论:抗生素降阶梯疗法治疗老年重症肺炎可提高临床疗效,减少炎症反应,改善免疫失衡及缺氧症状,有效促进患者康复,且安全可靠,是老年重症肺炎安全可行的优质治疗方案。Objective:To explore the effect of antibiotic de-escalation therapy on immune imbalance,clinical efficacy and safety in elderly patients with severe pneumonia.Methods:The clinical data of 96 elderly patients with severe pneumonia treated in our hospital from September 2017 to September 2020 were retrospectively analyzed.According to the method of antibiotic treatment,they were divided into control group(n=56)and research group(n=40).The control group was treated with conventional antibiotics treatment,and the research group was treated with antibiotic de-escalation therapy.The clinical efficacy,the fingertip blood oxygen saturation,plasma procalcitonin(PCT)level,serum interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)level and T lymphocyte subgroup(CD3^(+),CD4^(+),CD8^(+))counts level before and after treatment of the two groups were compared,and the ratio of CD4^(+)/CD8^(+)was calculated.The outcome indicators including intravenous antibiotics time,infection control time,hospital stay time,temperature return to normal time,cough relief time,white blood cell count return to normal time,and the occurrence of adverse reactions of the two groups were recorded.Results:The total effective rate of the research group(95.00%)was higher than that of the control group(80.36%,P<0.05).After treatment,fingertip blood oxygen saturation,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the two groups were higher than those before treatment,and plasma PCT level,serum IL-6 and TNF-αlevel,and CD8^(+)in the two groups were lower than those before treatment.The fingertip blood oxygen saturation,CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the research group were higher than those in the control group,and plasma PCT level,serum IL-6 and TNF-αlevel,and CD8^(+)in the research group were lower than those in the control group(P<0.05).The intravenous antibiotics time,infection control time,hospital stay time,temperature return to normal time,cough relief time,white blood cell count return to normal time in the research group were shorter than those in the

关 键 词：抗生素降阶梯疗法 重症肺炎 免疫失衡 临床疗效 安全性 

分 类 号：R974[医药卫生—药品]