美罗培南联合小剂量糖皮质激素治疗脓毒症休克患者的效果观察

何鸿志 郭壮波

[摘要] 目的 探讨美罗培南联合小剂量糖皮质激素治疗脓毒症休克患者的效果。 方法 将2018年1月至2020年1月60例脓毒症休克患者以简单随机化法分组，对照组（n=30）行小剂量糖皮质激素治疗，试验组（n=30）行美罗培南与小剂量糖皮质激素联合治疗，分析两组脓毒症休克患者治疗效果、治疗前后肝肺功能及炎症因子水平差异性。 结果 试验组总有效率高于对照组，差异有统计学意义（P<0.05）;两组治疗后AST、ALT均低于治疗前，两组治疗后PaO2/FiO2、PaO2均高于治疗前，差异有统计学意义（P<0.05）;同时，治疗后试验组AST、ALT低于对照组，PaO2/FiO2、PaO2高于对照组，差异有统计学意义（P<0.05）;两组治疗后的CRP、PCT水平均低于治疗前，差异有统计学意义（P<0.05）;试验组治疗后的CRP、PCT水平低于对照组，差异有统计学意义（P<0.05）。 结论 脓毒症休克患者接受美罗培南与小剂量糖皮质激素联合治疗，能够促进效果提高，更好地控制患者的C反应蛋白、降钙素原等水平，且可改善患者的血气、肝功能指标水平。

[关键词] 脓毒症休克;美罗培南;糖皮质激素;C反应蛋白;降钙素原

[中图分类号] R631.6          [文献标识码] A          [文章编号] 1673-9701（2021）31-0027-04

[Abstract] Objective To explore the effect of meropenem combined with low-dose glucocorticoid in the treatment of patients with septic shock. Methods A total of 60 patients with septic shock from January 2018 to January 2020 were divided into groups by a simple randomization method.The control group（n=30） was treated with low-dose corticosteroids，and the experimental group（n=30）was treated with meropenem combined with low-dose glucocorticoids.The differences in the treatment effects，liver and lung functions，and levels of inflammatory factors before and after treatment between the two groups were analyzed. Results The total effective rate of the experimental group was higher than the control group（P<0.05）.After treatment，the AST and ALT of the two groups were lower than those before treatment，PaO2/FiO2 and PaO2 of the two groups were higher than those before treatment（P<0.05）.After treatment，the AST and ALT of the experimental group after treatment was lower than the control group， the PaO2/FiO2 and PaO2 of the experimental group was higher than the control group（P<0.05）.The CRP，PCT levels of the two groups were lower than before treatment（P<0.05）.CRP and PCT levels after treatment in the experimental group were lower than those in the control group，and the difference was statistically significant（P<0.05）. Conclusion Combination therapy of meropenem and low-dose glucocorticoids in patients with septic shock can improve the effect，better control the levels of C-reactive protein and procalcitonin，and improve the blood gas and liver function of the patients，which is of great significance.

[Key words] Septic shock; Meropenem; Glucocorticoid; C-reactive protein; Procalcitonin

膿毒症是机体对感染的反应失调而导致危及生命的器官功能障碍，脓毒症可导致患者出现休克，即为患者实施足量液体复苏后仍然难以改善其组织低灌注，导致其出现血容量不足、酸碱平衡失调、昏迷等多脏器功能衰竭，对患者的生命安全造成威胁[1-2]。小剂量糖皮质激素应用于脓毒症休克患者虽可获得一定效果，但是单独应用则不理想。……