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2017 Nov;34(11)广西医科大学学报
参考文献:
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的危险预防控制对策[J]. 中华医院感染学杂志,
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[3] WHOCC. WHO collaborating centre for drug statistics
Effect of ceftazidime combined with doxofylline on serum levels of TNF-α,PDGF-B inpatients with chronic obstructive pulmonary diseaseChen Rong,Feng Yu.(Affiliated Dongtai People's Hospital of Nantong University,Dongtai 224200,China)
Abstract Objective: To investigate the effect of ceftazidime combined with doxofylline on serum levels of tu-
mor necrosis factor α(TNF-α)and platelet derived
growth factor-B(PDGF-B)in patients with chronic
obstructive pulmonary disease(COPD). Methods:106 COPD patients treated in our hospital from Jul.
·· 1604
慢性阻塞性肺气肿(chronic obstructive pulmo-
nary disease,COPD)是由慢性支气管炎或其他原因引
起的细支气管不完全阻塞或狭窄,终末细支气管远端
气腔过度充气,并伴有气腔壁膨胀、破裂,临床上常继
发慢性支气管炎、支气管哮喘和支气管扩张等;
COPD 患者治疗以支气管扩张药、糖皮质激素、祛痰
药等控制症状和改善肺功能为主,但很难治愈[1]。多
索茶碱片为黄嘌呤类药物,具良好的松弛支气管平滑
肌、镇咳的作用,能抑制磷酸二酯酶的活性,适用于缓
解 COPD 引起的可逆性支气管痉挛 [2]。临床实践表
明,COPD 的发病与细菌感染密切相关,而头孢他啶
为第三代头孢类广谱抗生素,抗菌效果良好,已广泛
应用于呼吸系统疾病的抗感染治疗[3]。氧化应激反应
及炎症机制在COPD的发生发展中起着重要作用 [4]。
血小板衍生生长因子 -B(platelet derived growth fac-
tor-B,PDGF-B)是氧化应激反应的下游产物。肿瘤坏
死因子(tumor necrosis factor,TNF-α)是一种重要的
炎症因子,参与机体的炎症反应。临床研究表明,
TNF-α、PDGF-B均在COPD患者肺动脉高压的发生、
发展中扮演重要角色,且对疾病发展和预后有重要意
义 [5]。本研究通过观察头孢他啶联合多索茶碱治疗
COPD肺气肿患者的临床疗效,探讨其对COPD肺气
肿患者外周血TNF-α、PDGF-B表达的影响,以期为该
病的临床治疗提供参考。
1 资料与方法
1. 1 一般资料
本研究对象为江苏省南通大学附属东台市人民
医院于 2014年 7月至 2016年 7月收治的 106例COPD
患者。将患者随机分为观察组与对照组,每组
53例。观察组中,男33例,女20例;年龄51~76岁,平
均(65. 2±3. 7)岁;平均病程(10. 18±3. 04)年;体重
指数(22. 96±3. 16)kg/m2;肺功能分级:Ⅱ级(1秒用
力呼气容积占预计值百分比(FEV1%)50%~<80%)
7 例 ,Ⅲ 级(30% ≤FEV1% <50% )41 例 ,Ⅳ 级
(FEV1%<30%)5 例。对照组中,男 34 例,女 19 例;
患者年龄 49~78 岁,平均(65. 4±3. 5)岁;平均病程
(11. 02±3. 10)年;体重指数(23. 12±3. 09)kg/m2;肺
功能分级:Ⅱ级 6例,Ⅲ级 43例,Ⅳ级 4例。两组患者
一般资料比较,差异无统计学意义(P>0. 05),具有可
比性。本研究经我院伦理委员会批准。
1. 2 病例纳入及排除标准
纳入标准:(1)符合COPD诊断标准[6];(2)符合肺
动气肿诊断标准;(3)年龄 40~80岁;(4)患者知情且
同意参与本研究方案。排除标准:(1)心、肝、肾功能
严重不全者;(2)排除全身免疫性疾病、恶性肿瘤、感
染性疾病者;(3)近期手术及 3个月出现心肌梗死者;
(4)对本研究方案药物过敏者;(5)不配合本研究治疗
方案者。
1. 3 治疗方法[7]
所有患者均给予补液、化痰、止咳、抗压、吸氧、吸
入激素以及营养支持等常规治疗。在此基础上,对照
组患者给予多索茶碱注射液[安士制药(中山)有限公
司,国药准字 H20052247]缓慢静脉注射,剂量:200
mg/次,隔 12 h一次。观察组患者在对照组治疗的基
础上给予注射用头孢他啶(上海新亚药业有限公司,
国药准字 H20084054)静脉注射 1. 0 g/次,隔 12 h 一
次。以7 d为1个疗程,所有患者均进行2个疗程的治
疗。治疗过程中密切观察患者的用药反应。
1. 4 观察指标
1. 4. 1 近期疗效 2个疗程后观察患者的近期疗效,
疗效判定标准[8]:(1)显效:患者的呼吸困难症状得到
了明显改善,其咳嗽和发绀症状显著好转,肺部鸣音
消失;(2)有效:患者的呼吸困难症状有所改善,咳嗽
和发绀症状有所减轻,肺部鸣音减弱;(3)无效:患者
的临床症状无明显好转甚至加重。总有效率=(显效
2014 to Jan. 2017 were selected and divided into a control group and an observation group,with 53 cases in
each group. The patients in the control group were treated with doxofylline,while those in the observation group
were treated with ceftazidime combined with doxofylline. The clinical effect,the pulmonary ventilation function,
serum TNF-α and PDGF-B levels before and after treatment,and the incidence of adverse reactions were com-
pared. Results: The response rate in the observation group was 92. 45%,which was significantly higher than
that in the control group(79. 24%)(P<0. 05). The maximal mid-expiratory flow(MMEF),peak expiratory
flow(PEF),and the percent of predicted forced expiratory volume in one second(FEV1%)were increased in
both groups,but the increases were more significant in the observation group(P<0. 05). After treatment,the
TNF-α and PDGF-B levels of the observation group were markedly lower than those of the control group(P<0. 05). No significant difference was noted in the incidence of adverse reactions between the two groups(P>0. 05). Conclusion: Ceftazidime combined with doxofylline could inhibit the inflammatory response,correct
the hypoxic injury,suppress the release of TNF-α and PDGF-B,relieve the progress of disease and improve the