林明

[摘要] 目的 分析抗生素降階梯治疗慢性阻塞性肺疾病（COPD）合并重症肺炎的价值。方法 采用前瞻性研究，于2015年10月—2018年6月收集南华大学附属第二医院COPD合并重症肺炎患者80例，随机数字法分为2组。对照组行常规抗生素治疗，观察组行降阶梯抗生素治疗，检测治疗前后肺功能指标FEV1、FEV1/FVC、FEV1占预计值百分比;检测两组T淋巴细胞亚群、应激反应指标血清丙二醛（MDA）、超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH-Px）;对比两组呼吸困难缓解时间、治疗前后圣乔治呼吸问卷（SGRQ）分值。结果 治疗后观察组FEV1[（1.60±0.21）L]、FEV1/FVC[（56.09±8.11）%]、FEV1占预计值百分比[（43.02±0.37）%]均高于对照组[（1.27±0.07）L、（50.91±7.06）%、（32.60±1.87）%]，差异有统计学意义（t=3.98、7.89、13.11，P=0.029、0.000、0.000）。治疗后两组患者CD3+、CD4+、CD8+均有所增高;其中观察组CD3+[（62.19±10.9）%]、CD4+[（39.02±7.66）%]较对照组高[（57.12±5.98）%、（34.34±4.98）%]，（t=14.54、14.21，P=0.000、0.000），应激反应指标SOD[（78.54±10.54） pg/mL]、GSH-PX[（158.45±21.37） U/mL]、较对照组[（74.45±13.23）pg/mL、（147.87±15.07）U/mL]高，差异有统计学意义（t=7.99、21.21，P=0.000、0.000）。治疗后观察组SGRQ分值[（9.32±2.18）分]较对照组[（14.34±1.98）分]低，呼吸困难环境时间较对照组短，差异有统计学意义（t=6.93、11.32，P=0.000、000）。结论 抗生素降阶梯法治疗慢性阻塞性肺疾病合并重症肺炎能改善肺功能、免疫功能，减少应激反应风险，改善短期生活质量。

[关键词] 抗生素降阶梯治疗;慢性阻塞性肺疾病;重症肺炎;疗效

[中图分类号] R563          [文献标识码] A          [文章编号] 1674-0742（2019）11（a）-0044-04

Antibiotic Ladder-down Therapy for Chronic Obstructive Pulmonary Disease Complicated With Severe Pneumonia

ZHAI Rong-fan，JIANG Xian-xun

Department of Critical Care Medicine，Second Affiliated Hospital of South China University，Hengyang，Hunan Province，421000 China

Abstract Objective To analyze the value of antibiotic ladder reduction in the treatment of chronic obstructive pulmonary disease （COPD） with severe pneumonia. Method A prospective study was conducted to collect 80 COPD patients with severe pneumonia in our hospital from October 2015 to June 2018. The patients were randomly divided into two groups.The control group was treated with routine antibiotics，The observation group was treated with step-down antibiotics.The percentage of FEV1， FEV1/FVC and FEV1 in predicted value before and after treatment were measured;T lymphocyte subsets， stress response indicators， serum malondialdehyde（MDA）， superoxide dismutase（SOD）， glutathione peroxidase （GSH-Px） were detected in the two groups.The relief time of dyspnea and the score of St. George's Respiratory Questionnaire（SGRQ） before and after treatment were compared between the two groups. Result After treatment， the percentage of FEV1[（1.60±0.21）L]， FEV1/FVC[（56.09±8.11）%]， FEV1 in the predicted value[（43.02±0.37）%] in the observation group were higher than those in the control group [（1.27±0.07）L， （50.91±7.06）%，（32.60±1.87）%]，The difference was significant（t=3.98，7.89，13.11， P=0.029， 0.000， 0.000）.After treatment， the levels of CD3+，CD4+，CD8+ in both groups increased， and the levels of CD3+ [（62.19+10.9）%]， CD4+ [（39.02±7.66）%] in the observation group were higher than those in the control group[（57.12±5.98）%，（34.34±4.98）%]，（t=14.54，14.21，P=0.000，0.000）.The stress response indexes SOD [（78.54±10.54）pg/mL]， GSH-PX[（158.45±21.37）U/mL]，were higher than those of the control group[（74.45±13.23）pg/mL，（147.87±15.07）U/mL].The difference was significant（t=7.99，21.21，P=0.000，0.000）.After treatment， the SGRQ score of the observation group[（9.32±2.18） points]was lower than that of the control group[（14.34±1.98）points]，The time of dyspnea environment was shorter than that of control group.The difference was significant（t= 6.93，11.32，P=0.000，0.000）.Conclusion Antibiotic ladder-down therapy can improve pulmonary function and immune function， reduce the risk of stress reaction and improve short-term quality of life in patients with chronic obstructive pulmonary disease complicated with severe pneumonia.

Key word：Antibiotic ladder-down therapy;Chronic obstructive pulmonary disease;Severe pneumonia;Curative effect

慢性阻塞性肺病是近年来备受关注的疾病之一，其发病率呈逐年升高趋势，已经成为威胁人类健康和生命的第四大疾病，“全球疾病負担研究项目”预测该病在2020年将成为威胁人类生命的第三大疾病。该病临床主要特征是气流受限，表现有咳嗽、咯痰和呼吸困难[1]。急性加重期COPD可导致肺功能降低，使患者健康状态恶化，后果严重。……