标题：乌司他丁联合美罗培南治疗老年重症肺炎的疗效及对患者肺氧合功能及血清C反应蛋白、降钙素原水平的影响

      作者：黎代强，陈琳，缪锦松，宋德彬，蒙自杰    贺州市人民医院重症医学科，广西 贺州 542899

      卷次： 2022年33卷1期

      【摘要】 目的 观察乌司他丁联合美罗培南治疗老年重症肺炎的疗效，并探讨其对患者的肺氧合功能及血清C反应蛋白(CRP)、降钙素原(PCT)水平的影响。方法 回顾性分析2018年12月至2020年12月于贺州市人民医院重症医学科治疗的118例老年重症肺炎患者的临床资料，按照治疗方式不同分为观察组和对照组各59例，对照组在常规治疗基础上给予美罗培南治疗，观察组在对照组治疗基础上联合乌司他丁治疗，均持续治疗1周。比较两组患者治疗1周后的临床疗效、一般治疗情况，以及治疗前后的动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数[PaO2/吸入氧浓度(FiO2)]、血清CRP、PCT水平和治疗期间的不良反应发生情况。结果 治疗后，观察组患者的临床疗效总有效率为89.83%，明显高于对照组的74.58%，差异有统计学意义(P<0.05)；观察组患者的机械通气时间、住院时间分别为(6.96±1.59) d、(16.02±3.71) d，明显短于对照组的(8.30±1.77) d、(20.93±2.84) d，再插管率为5.08%，明显低于对照组的 16.95%，差异均有统计学意义(P<0.05)；治疗后，观察组患者的 PaO2、氧合指数分别为(81.34±5.06) mmHg和 (305.94±14.0) mmHg，明显高于对照组的 (75.11±4.98) mmHg和 (269.21±16.32) mmHg，PaCO2为(55.02±3.75) mmHg，明显低于对照组的(62.26±4.87) mmHg，差异均有统计学意义(P<0.05)；治疗后，观察组患者的血清CRP、PCT水平分别为(6.20±0.65) mg/L、(0.64±0.11) ng/mL，明显低于对照组的(9.41±1.21) mg/L、(0.87±0.25) ng/mL，差异均有统计学意义(P<0.05)；两组患者治疗期间的不良反应总发生率分别为 13.56%和 11.86%，差异无统计学意义(P>0.05)。结论 乌司他丁联合美罗培南治疗老年重症肺炎可有效改善患者的肺氧合功能，降低血清CRP、PCT水平，促进疾病恢复，临床治疗效果显著。
      【关键词】 重症肺炎；美罗培南；乌司他丁；疗效；肺氧合功能；炎症因子；不良反应
      【中图分类号】 R563.1 【文献标识码】 A 【文章编号】 1003—6350（2022）01—0017—04

Effects of ulinastatin combined with meropenem on pulmonary oxygenation function and serum C-reactiveprotein and procalcitonin levels in elderly patients with severe pneumonia.
LI Dai-qiang, CHEN Lin, MIAOJin-song, SONG De-bin, MENG Zi-jie. Department of Critical Care Medicine, Hezhou People's Hospital, Hezhou 542899,Guangxi, CHINA
【Abstract】 Objective To observe the curative of ulinastatin combined with meropenem in the treatment of el-derly patients with severe pneumonia, and to explore its effect on pulmonary oxygenation function and serum C-reactiveprotein (CRP) and procalcitonin (PCT) levels. Methods The clinical data of 118 elderly patients with severe pneumo-nia, who admitted to Department of Critical Care Medicine of Hezhou People's Hospital from December 2018 to Decem-ber 2020, were analyzed retrospectively. The patients were divided into the observation group and control group by dif-ferent treatment methods, with 59 cases in each group. The control group was treated with meropenem on the basis ofconventional treatment, and the observation group was treated with ulinastatin on the basis of the treatment in the controlgroup, both for 1 week. The clinical efficacy at 1 week after treatment, the general treatment, and the changes of arterialpartial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), oxygenation index (PaO2/inhaled oxygenconcentration (FiO2)), serum CRP, PCT levels before and 1 week after treatment, and the adverse reactions during treat-ment were compared between the two groups. Results After treatment, the total effective rate in the observationgroup patients was 89.83%, which was significantly higher than 74.58% in the control group (P<0.05); the mechanicalventilation time and hospital stay in the observation group were (6.96±1.59) d and (16.02±3.71) d, which were signifi-cantly shorter than corresponding (8.30±1.77) d and (20.93±2.84) d in the control group, and the reintubation rate was5.08%, which was significantly lower than 16.95% in the control group (P<0.05); after treatment, the PaO2 and oxy-genation index in the observation group were (81.34±5.06) mmHg and (305.94±14.0) mmHg, which were significantlyhigher than corresponding (75.11 ± 4.98) mmHg and (269.21 ± 16.32) mmHg the control group, and the PaCO2 were(55.02±3.75) mmHg, which were significantly lower than (62.26±4.87) mmHg in the control group (P<0.05); after treat-ment, the serum CRP, PCT in the observation group were (6.20±0.65) mg/L, (0.64±0.11) ng/mL, which were significant-