广西医学

目的探讨碳青霉烯类抗生素联合血液滤过治疗脓毒性休克的临床效果。方法将100例脓毒性休克患者随机分为对照组和观察组，各50例。对照组患者接受碳青霉烯类抗生素治疗，观察组患者接受碳青霉烯类抗生素联合血液滤过治疗。比较两组患者治疗后的临床疗效，治疗前后的氧代谢指标［中心静脉血氧饱和度（ScvO2）、氧合指数（PaO2/FiO2）、乳酸］、血流动力学指标［中心静脉压（CVP）、心输出量（CO）、平均动脉压（MAP）］、炎症因子［C反应蛋白（CRP）、降钙素原（PCT）、白细胞计数（WBC）］、免疫功能（CD3+ T淋巴细胞、CD4+ T淋巴细胞、CD8+ T淋巴细胞、CD4+/CD8+值）及疾病严重程度［急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分和序贯器官衰竭评估（SOFA）评分］。结果治疗后，观察组的临床总有效率高于对照组（P<0.05）。治疗后，两组患者的ScvO₂、PaO₂/FiO₂、CVP、CO、MAP、CD3+ T淋巴细胞、CD4+ T淋巴细胞、CD4+/CD8+ 值高于治疗前，且观察组的上述指标高于对照组（P<0.05）；两组患者的乳酸水平、血清CRP及PCT水平、WBC、CD8+ T淋巴细胞、APACHEⅡ评分、SOFA评分低于治疗前，且观察组的上述指标低于对照组（P<0.05）。结论碳青霉烯类抗生素联合血液滤过治疗脓毒性休克能够改善患者的氧代谢及血流动力学状态，抑制炎症反应，促进免疫功能恢复，改善器官功能，具有较高的临床应用价值。

Objective To investigate the clinical effect of carbapenem antibiotics combined with hemofiltration for the treatment of septic shock. Methods A total of 100 patients with septic shock were randomly divided into control group or observation group, with 50 cases in each group. The control group received carbapenem antibiotic therapy, while the observation group received carbapenem antibiotics combined with hemofiltration for treatment. The clinical efficacy after treatment, pre⁃ and post⁃operative oxygen metabolism indicators with respect to central venous blood oxygen saturation (ScvO₂), oxygenation index (PaO₂/FiO₂), lactic acid, hemodynamic parameters in terms of central venous pressure (CVP), cardiac output (CO), mean arterial pressure (MAP), inflammatory factors including C⁃reactive protein (CRP), procalcitonin (PCT), white blood cell counts (WBC) , immune functions (CD3+, CD4+, and CD8+ T lymphocytes, as well as CD4+/CD8+ ratio), and disease severity with respect to Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ ) score and Sequential Organ Failure Assessment (SOFA) score were compared between patients of the two groups. Results After treatment, the total clinical effective rate in the observation group was higher than that in the control group (P<0.05). After treatment, both groups exhibited higher ScvO₂, PaO₂/FiO₂, CVP, CO, MAP, and CD3+, CD4+ T lymphocytes, and CD4+/CD8+ ratio as compared with before treatment; moreover, the observation group yielded higher indices as above as compared with the control group (P<0.05). Both groups interpreted lower lactic acid level, serum CRP and PCT levels, WBC, CD8+ T lymphocytes, APACHEⅡ score, and SOFA score compared to before treatment; in addition, the observation group exhibited lower aforementioned indices as compared with the control group (P<0.05). Conclusion Carbapenem antibiotics combined with hemofiltration for the treatment of septic shock can improve oxygen metabolism and hemodynamic state, suppress inflammatory response, improve immune function recovery, and ameliorated organ function, exerting relatively high clinical application value.