巩固 胡占升

[摘要] 目的 研究利奈唑胺联合盐酸氨溴索治疗呼吸机相关性肺炎（VAP）患者的效果及对血清胰石蛋白（PSP）、可溶性髓样细胞触发受体-1（sTREM-1）水平的影响。 方法 选取锦州市中心医院2016年10月～2017年10月收治的90例VAP患者，按照随机数字表法分为观察组和对照组，每组45例，其中对照组采用利奈唑胺治疗，观察组采用利奈唑胺和盐酸氨溴索治疗，两组均治疗7 d。比较两组患者临床疗效、临床指标，以及血清炎性因子、PSP和sTREM-1水平。 结果 治疗后，观察组总有效率、病原菌清除率、吸痰次数、机械通气时间、ICU住院时间以及血清炎性因子水平显著优于对照组（P < 0.05）。治疗后两组患者的血清PSP、sTREM-1水平较治疗前显著降低，其中观察组血清PSP、sTREM-1水平显著低于对照组（P < 0.05）。 结论 利奈唑胺联合盐酸氨溴索治疗VAP效果显著，可有效提高抗菌效力，降低血清PSP、sTREM-1水平，减轻炎性反应，改善预后。

[关键词] 呼吸机相关性肺炎；PSP；sTREM-1

[中图分类号] R563 [文献标识码] A [文章编号] 1673-7210（2018）09（a）-0140-04

[Abstract] Objective To analyze the effect of Linezolid combined with Ambroxol Hydrochloride on Ventilator associated pneumonia （VAP） and its effect on serum PSP/sTREM-1 levels. Methods A total of 90 patients with VAP admitted in Jinzhou Central Hospital from October 2016 to October 2017 were collected and they were divided into observation group and control group according to the random number table method， with 45 cases in each group. The control group was treated with Linezolid， while the observation group was treated with Linezolid and Ambroxol Hydrochloride. Both groups were treated for 7 days. The clinical efficacy， clinical indices， serum inflammatory factors， PSP and sTREM-1 levels were compared between the two groups. Results After treatment， the total effective rate， pathogen clearance rate， sputum suction times， mechanical ventilation time， the time of ICU hospitalization， and the serum inflammatory factor levels in the observation group were significantly better than those in the control group （P < 0.05）. Compared with before treatment， the serum levels of PSPN and TREM-1 in the two groups significantly decreased after treatment， and the levels of PSPN and TREM-1 in the observation group were significantly lower than those in the control group （P < 0.05）. Conclusion The combination of Linezolid and Ambroxol Hydrochloride has a significant effect in the treatment of VAP， that can effectively improve the antibacterial efficacy， reduce serum PSP and sTREM-1 levels， so as to improve inflammatory response and prognosis.

[Key words] Ventilator associated pneumonia； PSP； sTREM-1

呼吸机相关性肺炎（Ventilator associated pneumonia，VAP）主要由于患者接受呼吸机辅助通气48 h直至拔管后48 h之内因受致病菌感染而引起的获得性肺炎。VAP发病率较高，且缺乏有效的早期预防方法[1-3]。同时由于致病菌的天然耐药性，使得细菌的多重耐药情况日益严重[4-5]。利奈唑胺作为一种新型的噁唑烷酮类抗菌药物，对包括耐甲氧西林金黄色葡萄球菌（MRSA）在内的多种革兰阴性菌的抗菌效果显著[6]。老年患者由于自身免疫力、生理功能退化，导致接受机械通气过程中更容易发生VAP，从而引起各种炎性反应[7]，而盐酸氨溴索可加强受损呼吸道的纤毛运动和自净作用，减轻VAP患者的炎性反应。VAP的诊断和预后可通过高特异性的血清学指标进行评估和预测，其中胰石蛋白（PSP）可通过调控体内促炎、抗炎因子的水平而参与肺炎相关炎性反应。……