目的 探討胸腺五肽治療重癥肺炎合并膿毒血癥的臨床療效及對(duì)血清因子的影響。方法 選取2018年1月—2020年10月天津中醫(yī)藥大學(xué)第一附屬醫(yī)院重癥監(jiān)護(hù)室收治的70例重癥肺炎合并膿毒血癥患者，按照隨機(jī)數(shù)字表法分為對(duì)照組和治療組，每組各35例。對(duì)照組實(shí)施常規(guī)治療，治療組在常規(guī)治療基礎(chǔ)上靜脈滴注胸腺五肽注射液，將10 mg加入至0.9%氯化鈉注射液2 mL中，1次/d，持續(xù)7 d。觀察兩組的臨床療效和轉(zhuǎn)歸時(shí)間，比較兩組治療前后免疫功能指標(biāo)、炎癥因子指標(biāo)、肺功能指標(biāo)和動(dòng)脈血?dú)庵笜?biāo)的變化情況。結(jié)果 治療后，治療組患者的總有效率為97.14%，顯著高于對(duì)照組80.00%（P<0.05）。治療后，治療組休克逆轉(zhuǎn)時(shí)間、機(jī)械通氣時(shí)間、住院時(shí)間均顯著短于對(duì)照組（P<0.05）。治療后，兩組CD3⁺、CD4⁺/CD8⁺與治療前相比均顯著增高，但降鈣素原（PCT）、白細(xì)胞介素-6（IL-6）、腫瘤壞死因子-α（TNF-α）顯著降低（P<0.05）；治療后，治療組免疫功能和炎性因子指標(biāo)改善均優(yōu)于對(duì)照組（P<0.05）。治療后，兩組1秒用力呼吸容積（FEV₁）、FEV₁與肺活量比值（FEV₁/FVC）、動(dòng)脈血氧分壓（pO₂）均顯著增高，而動(dòng)脈血二氧化碳分壓（pCO₂）顯著降低（P<0.05）；治療后，治療組肺功能指標(biāo)和動(dòng)脈血?dú)庵笜?biāo)改善優(yōu)于對(duì)照組（P<0.05）。結(jié)論 胸腺五肽用于重癥肺炎合并膿毒血癥患者中，可改善患者免疫功能，減輕炎癥反應(yīng)、肺通氣障礙、動(dòng)脈血?dú)馕蓙y，從而盡快逆轉(zhuǎn)患者休克狀態(tài)，縮短其住院時(shí)間，且不良反應(yīng)少，安全性可靠。

Objective To explore the clinical efficacy of thymopentin in treatment of severe pneumonia complicated with sepsis and its effect on serum factors.Methods A total of 70 patients with severe pneumonia complicated with sepsis admitted to the ICU of First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from January 2018 to October 2020 were selected and randomly divided into control group and treatment group according to random number table method, with 35 patients in each group. The control group was given routine treatment, and patients in the treatment group were iv administered with Thymopentin Injection on the basis of routine treatment, 10 mg added into 0.9% Sodium Chloride Injection 2 mL, once daily, for 7 d. The clinical efficacy and prognosis time of the two groups were observed, and the changes of immune function indexes, inflammatory factors indexes, pulmonary function indexes and arterial blood gas indexes were compared between two groups before and after treatment.Results After treatment, the total effective rate in the treatment group was 97.14%, significantly higher than that in the control group (80.00%,P<0.05). After treatment, the time of shock reversal, mechanical ventilation and hospitalization in the treatment group were significantly shorter than those in the control group (P<0.05). After treatment, CD3⁺ and CD4⁺/CD8⁺ in two groups were significantly increased compared with before treatment, but procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were significantly decreased (P<0.05). After treatment, the improvement of immune function and inflammatory factors in treatment group was better than that in control group (P<0.05). After treatment, forced respiration volume in one second (FEV₁), FEV₁ to vital capacity ratio (FEV₁/FVC), and arterial partial pressure of oxygen (pO₂) were significantly increased in both groups, while arterial partial pressure of carbon dioxide (pCO₂) was significantly decreased (P<0.05). After treatment, the improvement of pulmonary function indexes and arterial blood gas indexes in treatment group was better than that in control group (P<0.05).Conclusion Thymopentin in treatment of severe pneumonia complicated with sepsis can improve the immune function of patients, and can reduce the inflammatory response, pulmonary ventilation disorder, and arterial blood gas disorder, so as to reverse the shock state of patients as soon as possible, shorten the length of hospital stay, which has fewer adverse reactions with safety and reliance.

R974