摘要
目的探讨无创呼吸机联合哌拉西林钠他唑巴坦钠治疗老年重症肺炎的效果及对炎症因子的影响。方法100例老年重症肺炎患者作为研究对象,依照随机数字表法分为对照组及研究组,各50例。两组患者均采用无创呼吸机进行机械通气治疗,在此基础上,对照组联合头孢哌酮钠舒巴坦钠治疗,研究组联合哌拉西林钠他唑巴坦钠治疗。比较两组疗效、症状消失时间、住院时间、症状评分、血清炎性因子水平、肺功能指标水平、动脉血气指标水平、不良反应发生率。结果研究组总有效率96.00%比对照组的82.00%高(P<0.05)。研究组咳痰消失时间、发热消失时间、气促消失时间、住院时间分别为(3.21±0.64)、(2.18±0.55)、(2.45±0.61)、(7.43±1.60)d,比对照组的(4.10±0.79)、(2.95±0.64)、(3.34±0.72)、(9.68±1.97)d短(P<0.05)。治疗后,两组咳痰、发热、气促评分均比治疗前降低,且研究组咳痰、发热、气促评分分别为(1.17±0.39)、(1.14±0.37)、(1.20±0.35)分,比对照组的(1.65±0.42)、(1.61±0.39)、(1.68±0.41)分低(P<0.05)。治疗后,两组C反应蛋白、降钙素原、白细胞介素-6均比治疗前降低,且研究组C反应蛋白、降钙素原、白细胞介素-6分别为(7.49±1.06)mg/L、(0.46±0.15)ng/ml、(12.75±3.40)pg/ml,比对照组的(9.02±1.27)mg/L、(0.69±0.23)ng/ml、(16.31±3.78)pg/ml低(P<0.05)。治疗后,两组第1秒用力呼气容积(FEV1)、FEV1与用力肺活量比值(FEV1/FVC)均比治疗前升高,且研究组FEV1(2.09±0.29)L、FEV1/FVC(63.94±5.07)%高于对照组的(1.78±0.26)L、(57.62±4.48)%(P<0.05)。治疗后,两组动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))均比治疗前改善,且研究组PaO_(2)(71.92±5.84)mm Hg(1 mm Hg=0.133 kPa)高于对照组的(63.54±5.26)mm Hg,PaCO_(2)(44.18±4.06)mm Hg低于对照组的(49.47±4.23)mm Hg(P<0.05)。两组不良反应发生率对比,无统计学差异(P>0.05)。结论老年重症肺炎患者采用无创呼吸机进行机械通气治疗,配合使用哌拉西林钠他唑巴坦钠进行抗感染治疗,具有良好的疗效,能够更快、更好地缓解症状,降低炎症因子水平,有助于改善患者的肺功能,调节动脉血气指标水平,并且哌拉西林钠他唑巴坦钠用药后的不良反应较少,具有良好安全性。
Objective To explore the effect of noninvasive ventilator combined with piperacillin sodium and tazobactam sodium on the treatment of severe pneumonia in the elderly and its influence on inflammatory factors.Methods 100 elderly patients with severe pneumonia as study subjects were grouped into a control group and a study group according to the random numerical table,with 50 patients in each group.Both groups were treated with mechanical ventilation by noninvasive ventilator.On this basis,the control group was treated with cefoperazone sodium and sulbactam sodium,and the study group was treated with piperacillin sodium and tazobactam sodium.Comparison of curative effect,time of symptom disappearance,length of hospital stay,symptom score,serum inflammatory factors,pulmonary function index,arterial blood gas index,and incidence of adverse reactions between the two groups.Results The total effective rate of the study group was 96.00%,which was higher than 82.00%of the control group(P<0.05).The time to disappearance of sputum,the time to disappearance of fever,the time to disappearance of shortness of breath,and the length of hospital stay were(3.21±0.64),(2.18±0.55),(2.45±0.61)and(7.43±1.60)d in the study group,which were shorter than(4.10±0.79),(2.95±0.64),(3.34±0.72),and(9.68±1.97)d in the control group(P<0.05).After treatment,the scores of expectoration,fever and shortness of breath in both groups were decreased compared with before treatment;the scores of expectoration,fever and shortness of breath were(1.17±0.39),(1.14±0.37)and(1.20±0.35)points in the study group,which were lower than(1.65±0.42),(1.61±0.39)and(1.68±0.41)points in the control group(P<0.05).After treatment,the C-reactive protein,procalcitonin and interleukin-6 were decreased in both groups compared with before treatment;in the study group,the C-reactive protein,procalcitonin and interleukin-6 were(7.49±1.06)mg/L,(0.46±0.15)ng/ml and(12.75±3.40)pg/ml,which were lower than(9.02±1.27)mg/L,(0.69±0.23)ng/ml and(16.31±3.78)pg/ml in the control group(P<0.05).After treatment,the forced expiratory volume in one second(FEV1)and the ratio of FEV1 to forced vital capacity(FEV1/FVC)in both groups were increased compared with before treatment;the study group had FEV1 of(2.09±0.29)L and FEV1/FVC of(63.94±5.07)%,which were higher than(1.78±0.26)L and(57.62±4.48)%in the control group(P<0.05).After treatment,the arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO_(2))in both groups were improved compared with before treatment;the study group had a higher PaO2 of(71.92±5.84)mm Hg(1 mm Hg=0.133 kPa)than(63.54±5.26)mm Hg in the control group,and a lower PaCO_(2) of(44.18±4.06)mm Hg than(49.47±4.23)mm Hg in the control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion For elderly patients with severe pneumonia,mechanical ventilation with non-invasive ventilator combined with anti-infection treatment with piperacillin sodium and tazobactam sodium has good curative effect,which can faster and better relieve symptoms,reduce inflammatory factors,help to improve the lung function,regulate arterial blood gas index,and it has less reactions and good safety.
作者
常振远
CHANG Zhen-yuan(Jinxiang County People's Hospital,Jining 272200,China)
出处
《中国现代药物应用》
2025年第11期18-23,共6页
Chinese Journal of Modern Drug Application
关键词
老年重症肺炎
无创呼吸机
机械通气
哌拉西林钠他唑巴坦钠
头孢哌酮钠舒巴坦钠
Severe pneumonia in the elderly
Noninvasive ventilator
Mechanical ventilation
Piperacillin sodium and tazobactam sodium
Cefoperazone sodium and sulbactam sodium
