抗菌药物降阶梯治疗对脓毒症患者肝脏功能影响及临床结局影响因素、预测价值分析  

Impact of de-escalation therapy with antimicrobial agents on liver function in sepsis patients and analysis of factors influencing clinical outcomes and predictive value in sepsis patients

作　　者：黄希乐 郑奎 王燕铭 HUANG Xile;ZHENG Kui;WANG Yanming(Emergency and Critical Care Unit,Luoyang Dongfang People's Hospital,Luoyang 471000,China)

机构地区：[1]洛阳市东方人民医院急诊重症监护室,河南洛阳471000

出　　处：《黑龙江医药科学》2025年第3期20-25,共6页Heilongjiang Medicine and Pharmacy

基　　金：河南省医学科技攻关计划项目,编号:LHGJ10610038。

摘　　要：目的:探究抗菌药物降阶梯治疗对脓毒症患者肝脏功能的影响,并分析影响脓毒症患者临床结局的因素及其预测价值。方法:选取2021年12月至2023年12月洛阳市东方人民医院重症监护病房收治的90例脓毒症患者,分为降阶梯组(n=49)和常规组(n=41)。常规组给予青霉素类药物或头孢抗菌药物,降阶梯组先选用广谱抗生素,后根据病原菌培养结果和药敏试验选择窄谱抗菌药物。观察治疗后不同时间点的肝功能指标、炎症因子和免疫功能指标,并分析临床结局的影响因素。结果:与常规组相比,降阶梯组治疗后3 d和7 d的炎症因子水平显著降低(P<0.05),免疫功能指标显著升高(P<0.05);同时,肝功能指标也显著降低(P<0.05)。单因素分析显示,年龄、急性生理与慢性健康评价(acute physiology and chronic health evaluation Ⅱ,APACHE Ⅱ)评分、院内感染、脓毒性休克、治疗方式、机械通气、糖尿病、高血压、总胆红素、谷丙转氨酶、谷草转氨酶、碱性磷酸酶等指标与脓毒症患者临床结局显著相关(P<0.05)。Logistic回归分析表明,脓毒性休克、APACHEⅡ评分、降钙素原、降阶梯治疗、糖尿病、机械通气和碱性磷酸酶是影响脓毒症患者死亡发生的独立因素。结论:抗菌药物降阶梯治疗能显著改善脓毒症患者的肝功能、炎症因子和免疫功能指标,降低死亡率。脓毒性休克、APACHEⅡ评分、降钙素原、降阶梯治疗、糖尿病、机械通气和碱性磷酸酶是预测脓毒症患者临床结局的重要指标,具有较高的预测价值。Objective:To investigate the impact of de-escalation therapy with antimicrobial agents on liver function in patients with sepsis and analyze the factors influencing clinical outcomes in sepsis patients as well as their predictive value.Methods:90 sepsis patients admitted to the Intensive Care Unit of Luoyang Dongfang People's Hospital from December 2021 to December 2023 were selected and divided into de-escalation group(n=49)and conventional group(n=41).The conventional group received penicillin or cephalosporin antibiotics,while the de-escalation group initially received broad-spectrum antibiotics and then switched to narrow-spectrum antibiotics based on pathogen culture results and drug sensitivity tests.Liver function indicators,inflammatory cytokines and immune function indicators were observed at different time points after treatment,and the factors influencing clinical outcomes were analyzed.Results:Compared with the conventional group,the de-escalation group had significantly lower levels of inflammatory cytokines(P<0.05)and significantly higher immune function indicators(P<0.05)at 3 and 7 days after treatment.Additionally,liver function indicators were also significantly reduced in the de-escalation group(P<0.05).Univariate analysis showed that age,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score,nosocomial infection,septic shock,treatment method,mechanical ventilation,diabetes,hypertension,total bilirubin,alanine aminotransferase,aspartate aminotransferase and alkaline phosphatase were significantly associated with clinical outcomes in sepsis patients(P<0.05).Logistic regression analysis indicated that septic shock,APACHE Ⅱ score,procalcitonin,de-escalation therapy,diabetes,mechanical ventilation and alkaline phosphatase were independent factors influencing mortality in sepsis patients.Conclusion:De-escalation therapy with antimicrobial agents can si nificantly improve liver function,inflammatory cytokines and immune function indicators in sepsis patients and reduce mortality.Septic

关 键 词：降阶梯治疗 脓毒症 肝脏功能 临床结局 影响因素 

分 类 号：R541[医药卫生—心血管疾病]