摘要
目的:探讨连续性静脉-静脉血液透析滤过(CVVHDF)协同乙酰毛花苷及美罗培南对老年重症肺炎并心力衰竭患者炎症因子及心肌损伤指标的影响.方法:选取 2020 年 6 月—2023 年 5 月广东省人民医院赣州医院收治的 82 例老年重症肺炎并心力衰竭患者进行分析,随机分为CVVHDF组(采用CVVHDF协同乙酰毛花苷及美罗培南治疗,n=41)和药物组(采用乙酰毛花苷联合美罗培南治疗,n=41).分析比较两组ICU滞留时间、总住院时间、咳嗽缓解时间、肺啰音消失时间、炎症因子[血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平]、心肌损伤指标[肌酸激酶(CK)、乳酸脱氢酶(LDH)、血清肌钙蛋白I(cTnI)]、血气指标[动脉血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)水平]及急性生理与慢性健康状况评价Ⅱ(APACHEⅡ).结果:CVVHDF组ICU滞留时间、总住院时间均短于药物组,咳嗽缓解时间、肺啰音消失时间均早于药物组(P<0.05);治疗后,两组血清PCT、CRP、IL-6 水平均降低,与药物组相比,CVVHDF组均更低(P<0.05);治疗后,两组CK、LDH、血清cTnI水平均降低,与药物组相比,CVVHDF组均更低(P<0.05);治疗后,两组血清PaCO2 水平、APACHEⅡ评分均降低,与药物组相比,CVVHDF组均更低(P<0.05);治疗后,两组PaO2、SaO2 水平均明显提高,与药物组相比,CVVHDF组均更高(P<0.05).结论:CVVHDF协同乙酰毛花苷及美罗培南用于治疗老年重症肺炎合并心力衰竭患者,可明显改善心肌功能,提高通气功能,同时可以降低机体炎症反应,加速康复进程.
Abstract
Objective:To investigate the effect of continuous veno-venous hemodiafiltration(CVVHDF)in combination with Acetyl Piloside and Meropenem on inflammatory factors and myocardial injury indicators in elderly patients with severe pneumonia and heart failure.Method:From June 2020 to May 2023,82 elderly patients with severe pneumonia and heart failure admitted to Ganzhou Hospital,Guangdong Provincial People's Hospital were selected and analyzed.They were randomly divided into CVVHDF group(treatment with CVVHDF in combination with Acetyl Piloside and Meropenem,n=41)and drug group(treatment with Acetyl Piloside combined with Meropenem,n=41).The ICU stay time,total hospitalization time,cough relief time,lung rale disappearance time,inflammatory factors[serum procalcitonin(PCT),C reactive protein(CRP),interleukin-6(IL-6)levels],myocardial injury indicators[creatine kinase(CK),lactate dehydrogenase(LDH),serum troponin I(cTnI)],blood gas indicators[arterial oxygen saturation(SaO2),arterial carbon dioxide pressure(PaCO2),arterial oxygen pressure(PaO2)levels]and acute physiological and chronic health evaluation Ⅱ(APACHEⅡ)were analyzed and compared between the two groups.Result:The retention time in ICU,total hospitalization time of the CVVHDF group were shorter than those of the drug group,cough relief time and pulmonary rales disappearance time of the CVVHDF group were earlier than those of the drug group(P<0.05).After treatment,the serum PCT,CRP and IL-6 levels in the two groups decreased,compared with the drug group,those in the CVVHDF group were lower(P<0.05).After treatment,the levels of CK,LDH and serum cTnI decreased in both groups,compared with the drug group,those in the CVVHDF group were lower(P<0.05).After treatment,the serum PaCO2 levels and APACHEⅡ scores in both groups decreased,compared with the drug group,those in the CVVHDF group were lower(P<0.05);after treatment,the levels of PaO2 and SaO2 in both groups significantly increased,and compared with the drug group,those in the CVVHDF group were higher(P<0.05).Conclusion:CVVHDF in combination with Acetyl Piloside and Meropenem in the treatment of elderly patients with severe pneumonia and heart failure can significantly improve their myocardial function,improve their ventilatory function,reduce their inflammatory reaction,and accelerate their rehabilitation process.
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