克拉霉素对脓毒症合并多器官功能障碍综合征患者预后的影响  

Effect of clarithromycin on patients with sepsis and multiple organ dysfunction syndrome

作　　者：谢琼燕 许环清 叶文 吴泽 XIE Qiongyan;XU Huanqing;YE Wen;WU Ze(Department of Emergency Medicine,Haikou Affiliated Hospital of Central South University Xiangya School of Medicine,Haikou 570100;Department of Ultrasonograghy,Hainan Provincial People's Hospital,Haikou 570100,China)

机构地区：[1]中南大学湘雅医学院附属海口医院急诊科,海口570100 [2]海南省人民医院超声科,海口570100

出　　处：《空军航空医学》2023年第6期525-529,共5页AVIATION MEDICINE OF AIR FORCE

基　　金：海南省自然科学基金(201922518)。

摘　　要：目的探讨克拉霉素对脓毒症合并多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者预后的影响。方法采用随机对照试验设计,将2019年11月—2022年12月在中南大学湘雅医学院附属海口医院收治的125名脓毒症合并MODS患者随机分为观察组(62例)和对照组(63例)。观察组在常规治疗基础上加用克拉霉素,1 g/d,连续4 d;对照组仅接受常规治疗。主要观察指标为28 d病死率;次要观察指标为28 d内脓毒症发作人数、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)发生率、住院时间及90 d病死率等。结果研究截止第28天,观察组脓毒症发作率(17.74%)低于对照组(38.10%),差异有统计学意义(OR=0.56,95%CI=0.33~0.93,P=0.02)。COX回归分析结果显示,急性呼吸窘迫综合征(HR=0.51,95%CI:0.29~0.87,P=0.01)和SOFA(HR=0.54,95%CI:0.31~0.94,P=0.03)对患者的生存时间的影响差异具有统计学意义。结论使用克拉霉素治疗对脓毒症合并M ODS患者的病死率无显著影响,但克拉霉素能改善患有急性呼吸窘迫综合征的脓毒症患者的生存时间。Objective To find out whether clarithromycin can reduce 28-day mortality in patients with sepsis,respiratory and multiple organ dysfunction syndrome(MODS).Methods A randomized controlled trial was conducted among the 125 patients with sepsis and MODS admitted to our hospital between November 2019 and December 2022.The patients were randomly assigned to the observation group(n=62)and the control group(n=63).The observation group received intravenous injection of clarithromycin,1 g per day,for 4 consecutive days,in addition to routine treatment while the control group received routine treatment only.The primary outcome was 28-day mortality while the secondary outcomes included the number of sepsis episodes within 28 days,scores of sequential organ failure assessment(SOFA),incidence of acute respiratory distress syndrome(ARDS)length of hospital stay and 90-day mortality.Results By day 28,the observation group had a lower rate of sepsis episodes(17.74%)than the control group(38.10%),and the difference was statistically significant(OR=0.56,95%CI=0.33-0.94,P=0.02).COX regression analysis showed that acute respiratory distress syndrome(HR=0.51,95%CI:0.29-0.87,P=0.01)and SOFA(HR=0.54,95%CI:0.31-0.94,P=0.03)had a statistically significant impact on the survival of patients.Conclusion Clarithromycin treatment has no significant effect on the mortality of patients with sepsis and MODS,but it can improve the survival of septic p atients w ith a cute respiratory distress syndrome.

关 键 词：克拉霉素 脓毒症 多器官功能障碍综合征 急性呼吸窘迫综合征 生存分析 序贯器官衰竭估计评分 

分 类 号：R631[医药卫生—外科学] R565[医药卫生—临床医学]