目的 探討清開(kāi)靈注射液聯(lián)合亞胺培南西司他丁鈉治療老年重癥肺炎的臨床療效。方法 選取2017年1月—2020年6月在濮陽(yáng)市油田總醫(yī)院進(jìn)行治療的62例老年重癥肺炎患者為研究對(duì)象，依據(jù)就診順序分為對(duì)照組和治療組，每組各31例。對(duì)照組靜脈滴注注射用亞胺培南西司他丁鈉，20 mL/次同生理鹽水100 mL配伍，每隔8 h靜脈滴注1次；治療組在對(duì)照組基礎(chǔ)上給予清開(kāi)靈注射液20 mL同生理鹽水100 mL配伍，每隔12 h靜脈滴注1次。兩組均進(jìn)行10 d治療后進(jìn)行效果比較。觀察兩組的臨床療效，比較兩組臨床癥狀恢復(fù)時(shí)間、肺功能指標(biāo)、血?dú)夥治鲋笜?biāo)和血清學(xué)指標(biāo)的變化情況。結(jié)果 治療后，治療組總有效率96.77%顯著高于對(duì)照組的80.65%（P<0.05）。經(jīng)治療，治療組患者體溫恢復(fù)時(shí)間、咳嗽消失時(shí)間、呼吸困難消失時(shí)間、肺部啰音消失時(shí)間顯著短于對(duì)照組（P<0.05）。治療后，兩組第1秒用力呼氣量（FEV1）、用力肺活量（FVC）、呼氣流量峰值（PEF）均較治療前顯著增加（P<0.05）；治療后，治療組這些肺功能指標(biāo)顯著高于對(duì)照組（P<0.05）。經(jīng)治療，兩組氧分壓（pO₂）、氧合指數(shù)（pO₂/FiO₂）均顯著升高，而二氧化碳分壓（pCO₂）均顯著降低（P<0.05）；治療后，治療組這些血?dú)夥治鲋笜?biāo)優(yōu)于對(duì)照組（P<0.05）。經(jīng)治療，兩組血清超敏C反應(yīng)蛋白（hs-CRP）、降鈣素原（PCT）、可溶性髓系細(xì)胞觸發(fā)受體（sTREM-1）、高遷移率族蛋白1（HMGB1）均較治療前顯著降低，而SP蛋白（SP-D）、可溶性尿激酶型纖溶酶原激活物受體（suPAR）均顯著升高（P<0.05）；治療后，治療組這些血清學(xué)指標(biāo)顯著優(yōu)于對(duì)照組（P<0.05）。結(jié)論 清開(kāi)靈注射液聯(lián)合亞胺培南西司他丁鈉治療老年重癥肺炎具有較好的臨床療效，可有效改善患者肺功能和血?dú)夥治鲋笜?biāo)，促進(jìn)機(jī)體細(xì)胞因子水平改善，具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of Qingkailing Injection combined with imipenem and cilastatin sodium in treatment of severe pneumonia in the elderly. Methods 62 elderly patients with severe pneumonia who were treated in Puyang Oilfield General Hospital from January 2017 to June 2020 were selected as study subjects, and they were divided into control group and treatment group according to the order of treatment, with 31 patients in each group. Patients in the control group were iv administered with Imipenem and Cilastatin Sodium for injection, 20 mL/time was compatible with 100 mL normal saline, and intravenous infusion was performed once every 8 h. Patients in the treatment group were iv administered with Qingkailing Injection on the basis of the control group, 20 mL was compatible with 100 mL normal saline, and intravenous infusion was performed once every 12 h. The effects of the two groups were compared after treatment for 10 days. The clinical efficacy of the two groups was observed, and the changes of clinical symptom recovery time, lung function indexes, blood gas analysis indexes and serological indexes in the two groups were compared. Results After treatment, the total effective rate of 96.77% in the treatment group was significantly higher than 80.65% in the control group (P<0.05). After treatment, the temperature recovery time, cough extinction time, dyspnea extinction time and lung rhonchus extinction time in the treatment group were significantly shorter than those in the control group (P<0.05). After treatment, forced expiratory volume (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) in both groups were significantly higher than those before treatment (P<0.05). After treatment, these lung function indexes in the treatment group were significantly higher than those in the control group (P<0.05). After treatment, oxygen partial pressure (pO₂) and oxygenation index (pO₂/FiO₂) were significantly increased in both groups, while carbon dioxide partial pressure (pCO₂) was significantly decreased in both groups (P<0.05). After treatment, the blood gas analysis indexes of the treatment group were better than those of the control group (P<0.05). After the treatment, serum hypersensitive C-reactive protein (hs-CRP), calcitonin (PCT), soluble myeloid cells trigger receptor (sTREM-1) and high mobility group protein 1 (HMGB1) in two groups was significantly reduced, but SP protein (SP-D), soluble urokinase type fibrinolytic enzyme receptor (suPAR) was significantly increased (P<0.05). After treatment, these serological indicators in the treatment group were significantly better than those in the control group (P<0.05). Conclusion Qingkailing Injection combined with imipenem and cilastatin sodium has good clinical effect in treatment of severe pneumonia in the elderly, and can effectively improve patients' lung function and blood gas analysis indicators, and promote the improvement of the body's cytokine levels, which has certain clinical application value.

R974

四川省中醫(yī)藥科學(xué)技術(shù)研究專項(xiàng)項(xiàng)目（20160086）