王庆 刘宏波 方潇婷 郑雪婷 张建生 安志鹏

[摘要] 目的 探討血必净注射液对呼吸机相关性肺炎（VAP）患者炎症级联反应以及预后因素的影响。方法 采用前瞻性研究方法，以2018年7月至2019年7月福建中医药大学附属第三人民医院重症医学科收治的70例VAP患者为研究对象。随机将入组患者分为治疗组（n=37）和对照组（n=33），两组均参照中国HAP/VAP指南进行综合治疗，治疗组加用血必净注射液（100 mL，Bid），疗程7 d，分别于治疗前及治疗3、7、10 d记录两组APACHE Ⅱ评分、SOFA评分，检测WBC、CRP、PCT及IL-6水平，并统计机械通气时间、入住ICU时间及28 d死亡率。比较组间差异，分析与预后相关的因素。结果 ①治疗7 d时，治疗组WBC、IL-6较对照组降低，治疗10 d时治疗组WBC、CRP、PCT、IL-6均明显降低（P<0.05）。②治疗组可明显缩短机械通气时间及入住ICU时间（P<0.05），但28 d死亡率组间比较无统计学差异（P>0.05）。③IL-6及APACHE Ⅱ评分是影响VAP患者预后的独立危险因素（P<0.05）。 结论 血必净注射液能够减轻VAP患者的炎症反应，缩短机械通气时间及入住ICU时间，但并不能降低VAP患者28 d死亡率。

[关键词] 血必净注射液;呼吸机相关性肺炎;炎症反应;预后因素

[中图分类号] R563.1          [文献标识码] A          [文章编号] 1673-9701（2021）33-0015-04

[Abstract] Objective To explore the effect of Xuebijing injection on inflammatory cascade reaction and prognostic factors in patients with ventilator-associated pneumonia （VAP）. Methods A prospective study was conducted on 70 VAP patients admitted to the Department of Critical Care Medicine of the Third Affiliated People′s Hospital of Fujian University of Traditional Chinese Medicine from July 2018 to July 2019 selected as research objects. Patients were randomly divided into the treatment group （n=37） and the control group （n=33）. Both groups were given comprehensive treatment according to Chinese HAP/VAP guidelines. The treatment group was given Xuebijing injection （100 mL， Bid） for 7 days. APACHE Ⅱ score and SOFA score were recorded before treatment and on the 3rd， 7th and 10th day of treatment， respectively， and levels of White Blood Cell Count （WBC）， C-reactive protein （CRP）， procalcitonin （PCT） and Interleukin-6（IL-6） were detected. The mechanical ventilation time， duration in ICU and 28-day mortality was counted. The differences between groups were compared and the factors related to prognosis were analyzed. Results ①The WBC and IL-6 in the treatment group were lower than those in the control group on the 7th day of treatment， while the WBC， CRP， PCT and IL-6 in the treatment group were significantly lower on the 10th day of treatment（P<0.05）. ②The treatment group can obviously shorten the time of mechanical ventilation and the duration in ICU（P<0.05）， but there was no statistically significant difference in 28-day mortality（P>0.05）. ③IL-6 and APACHE Ⅱ scores were independent risk factors affecting the prognosis of VAP patients （P<0.05）. Conclusion Xuebijing injection can alleviate the inflammatory reaction of VAP patients， shorten the time of mechanical ventilation and duration in ICU， but it can′t reduce the 28-day mortality of VAP patients.

[Key words] Xuebijing injection; Ventilator associated pneumonia; Inflammatory reaction; Prognostic factors

呼吸机相关性肺炎（Ventilator-associated pneumonia，VAP）是导致危重症患者死亡的重要原因[1]。研究结果显示[2-3]，VAP的发病率为2.0%～48.4%，死亡率为13.0%～43.2%。近年来，重症监护病房（Intensive care unit，ICU）中 VAP 的发生率及死亡率仍居高不下，如炎症反应持续发展，可进展为感染性休克及多器官功能障碍综合征（Multiple organ dysfunction syndrome，MODS）。在严重感染时尽早使用凉血活血药物可能防止脓毒症休克及MODS的发生、发展。血必净注射液对重症肺炎[4-5]、脓毒症[6-8]及MODS[9]等具有确切疗效，已广泛应用于危重症患者，未发现严重不良反应[10-11]。本研究旨在探讨血必净注射液对VAP患者炎症反应及预后的影响，现报道如下。

1 资料与方法

1.1 一般资料

本研究方案经我院医学伦理委员……