大青龙汤加减联合利奈唑胺治疗新生儿败血症
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摘要
目的:探讨大青龙汤加减联合利奈唑胺治疗新生儿败血症临床疗效。方法:将68例新生儿败血症患儿依照随机数字表法分为两组,各34例。对照组采用利奈唑胺治疗,观察组在对照组基础上联合大青龙汤加减治疗,两组均持续治疗5 d。治疗后比较两组患儿有效率、不良反应发生率、神经系统症状改善时间、体温改善时间、住院时间,入院时及治疗5 d后急性生理和慢性健康状况评估Ⅱ(acute physiology and chronic health evalⅡ,APACHEⅡ)评分、全身炎症反应综合征(systemic Inflammatory response syndrome,SIRS)评分及外周血中性粒细胞、白细胞、CD_(14)~+、CD_(16)~+细胞计数,并比较两组入院时及治疗5 d后血清C反应蛋白(C reactive protein,CRP)、白细胞介素-10(Interleukin-10,IL-10)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平。结果:治疗5 d后观察组有效率88.24%高于对照组的64.71%,差异有统计学意义(P<0.05);神经系统症状改善时间、体温改善时间、住院时间分别为(5.64±1.32) h、(3.92±0.85) h、(7.75±1.69) d,均显著短于对照组,差异有统计学意义(P<0.05);治疗5 d后观察组APACHEⅡ、SIRS评分及外周血中性粒细胞、白细胞、CD_(14)~+、CD_(16)~+细胞计数均低于对照组,差异有统计学意义(P<0.05);观察组治疗5 d后血清CRP、TNF-α水平均低于对照组,IL-10水平高于对照组,差异有统计学意义(P<0.05);治疗期间,观察组不良反应发生率17.65%与对照组14.71%相比,差异无统计学意义(P>0.05)。结论:大青龙汤加减联合利奈唑胺治疗新生儿败血症疗效显著,可改善患儿免疫状态,提高抗感染、抗炎功能,促进患儿康复,且不良反应较少。
Objective:To investigate the clinical efficacy of Daqinglong Decoction combined with linezolid in treatment of neonatal sepsis.Methods:68 children with neonatal sepsis were divided into two groups according to the random number table method,34 cases each.The control group was treated with linezolid,and the observation group was treated with Daqinglong Decoction.The two groups were treated for 5 days.After treatment,the effective rate,incidence of adverse reactions,improvement of neurological symptoms,time of improvement of body temperature,length of hospital stay,admission and 5 days after treatment,acute physiology and chronic health eval Ⅱ,APACHE Ⅱ score,systemic Inflammatory response syndrome(SIRS) score and peripheral blood neutrophil,leukocyte,CD_(14)~+CD_(16)~+ cell count,and serum C after hospitalization and 5 days after treatment C reactive protein(CRP),interleukin-10(IL-10) tumor necrosis factor-α(TNF-α) levels of both groups were compared.Results:After 5 days of treatment,the effective rate of the observation group was 88.24% higher than that of the control group(64.71%).The time of improvement of neurological symptoms,time of body temperature improvement,and hospitalization time were(5.64±1.32) h,(3.92±0.85) h,(7.75 ±1.69) d respectively,being shorter than that of the control group and the difference being statistically significant(P<0.05);after 5 days of treatment,the APACHEⅡ,SIRS scores and peripheral blood neutrophils,white blood cells,CD_(14)~+CD_(16)~+ cell counts were observed in the observation group.The difference was statistically significant(P<0.05).The serum CRP and TNF-α levels in the observation group were lower than those in the control group after 5 days of treatment,and the IL-10 level was higher than that in the control group.The difference was statistically significant(P<0.05).During the treatment,the incidence of adverse reactions in the observation group was 17.65% compared with 14.71% in the control group,and the difference was not statistically significant(P>0.05).Conclusion:Daqinglong Decoction combined with linezolid is effective in the treatment of neonatal sepsis,which can improve the immune status of children,enhance the anti-infective and anti-inflammatory effects,promote the recovery of children,and have fewer adverse reactions.
Objective:To investigate the clinical efficacy of Daqinglong Decoction combined with linezolid in treatment of neonatal sepsis.Methods:68 children with neonatal sepsis were divided into two groups according to the random number table method,34 cases each.The control group was treated with linezolid,and the observation group was treated with Daqinglong Decoction.The two groups were treated for 5 days.After treatment,the effective rate,incidence of adverse reactions,improvement of neurological symptoms,time of improvement of body temperature,length of hospital stay,admission and 5 days after treatment,acute physiology and chronic health eval Ⅱ,APACHE Ⅱ score,systemic Inflammatory response syndrome(SIRS) score and peripheral blood neutrophil,leukocyte,CD_(14)~+CD_(16)~+ cell count,and serum C after hospitalization and 5 days after treatment C reactive protein(CRP),interleukin-10(IL-10) tumor necrosis factor-α(TNF-α) levels of both groups were compared.Results:After 5 days of treatment,the effective rate of the observation group was 88.24% higher than that of the control group(64.71%).The time of improvement of neurological symptoms,time of body temperature improvement,and hospitalization time were(5.64±1.32) h,(3.92±0.85) h,(7.75 ±1.69) d respectively,being shorter than that of the control group and the difference being statistically significant(P<0.05);after 5 days of treatment,the APACHEⅡ,SIRS scores and peripheral blood neutrophils,white blood cells,CD_(14)~+CD_(16)~+ cell counts were observed in the observation group.The difference was statistically significant(P<0.05).The serum CRP and TNF-α levels in the observation group were lower than those in the control group after 5 days of treatment,and the IL-10 level was higher than that in the control group.The difference was statistically significant(P<0.05).During the treatment,the incidence of adverse reactions in the observation group was 17.65% compared with 14.71% in the control group,and the difference was not statistically significant(P>0.05).Conclusion:Daqinglong Decoction combined with linezolid is effective in the treatment of neonatal sepsis,which can improve the immune status of children,enhance the anti-infective and anti-inflammatory effects,promote the recovery of children,and have fewer adverse reactions.
引文
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[3]陈国庆.头孢噻肟联合丙种球蛋白治疗新生儿败血症的疗效及对C反应蛋白、降钙素原和CD64的影响[J].儿科药学杂志,2015,21(6):21-23.
[4]陈婷,陆勤,杨力,等.新生儿败血症的病原菌分布及耐药性分析[J].临床儿科杂志,2014,32(3):220-223.
[5]刘伟,陈玲,专晨昱.利奈唑胺治疗新生儿败血症的临床疗效和安全性[J].中国当代儿科杂志,2015,17(4):405-407.
[6]肖勇洪,刘春丽,徐梦,等.大青龙汤方证释疑[J].浙江中医药大学学报,2016,40(7):540-542.
[7]中华医学会儿科学分会新生儿学组.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
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[10]陈娇,钱晓明,任艺,等.MEWS评分、SIRS评分和APACHEⅡ评分对急诊颅脑外伤患者预后评估的对比研究[J].临床急诊杂志,2013,14(11):528-531.
[11]PASHA Y Z,AHMADPOURKACHO M,BEHMADI R,et al.3-Day versus 5-Day Course of Intravenous Antibiotics for Suspected Early Onset Neonatal Sepsis:A Randomized Controlled Trial[J].Iranian J Pediatrics,2014,24(6):673-678.
[12]徐艳,由军,毛春梅,等.新生儿败血症的临床特征、病原菌分布及耐药特点分析[J].哈尔滨医科大学学报,2016,50(2):156-158.
[13]唐莲,王三南,翁小红,等.利奈唑胺治疗新生儿败血症的疗效及对血小板的影响[J].药物不良反应杂志,2016,18(2):99-104.
[14]郭大斌,陈丽,雷永珍,等.大青龙汤联合西药治疗败血症的临床研究[J].中华中医药学刊,2014,32(5):1216-1218.
[15]戴琪,周元科,黄婕,等.大青龙汤方中桂枝-生姜药对的超临界CO2萃取物的血清药化学研究[J].湖北中医药大学学报,2014,16(3):52-56.
[16]肖佩玉,万正兰,黄际薇.大青龙汤对流感病毒感染小鼠血清与肺组织中免疫因子的影响研究[J].中华医院感染学杂志,2016,26(3):537-539.
[17]马劲夫,张纪元,周银苹,等.脓毒症患者CD14+CD16+单核细胞的作用探讨[J].中国急救复苏与灾害医学杂志,2013,8(8):717-720.
[18]廖崇伦.降钙素原和超敏C反应蛋白联合检测对新生儿败血症的诊断价值[J].新乡医学院学报,2013,30(3):218-220.
[19]王浩,陈志勇,汪文娟.TNF-α和IL-10在小儿败血症预后判断中的应用价值[J].中国卫生检验杂志,2013,23(3):706-707.
[2]朱银燕.中西医结合治疗新生儿败血症临床观察[J].中国中医急症,2016,25(6):1258-1260.
[3]陈国庆.头孢噻肟联合丙种球蛋白治疗新生儿败血症的疗效及对C反应蛋白、降钙素原和CD64的影响[J].儿科药学杂志,2015,21(6):21-23.
[4]陈婷,陆勤,杨力,等.新生儿败血症的病原菌分布及耐药性分析[J].临床儿科杂志,2014,32(3):220-223.
[5]刘伟,陈玲,专晨昱.利奈唑胺治疗新生儿败血症的临床疗效和安全性[J].中国当代儿科杂志,2015,17(4):405-407.
[6]肖勇洪,刘春丽,徐梦,等.大青龙汤方证释疑[J].浙江中医药大学学报,2016,40(7):540-542.
[7]中华医学会儿科学分会新生儿学组.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
[8]国家中医药管理局.中医病证诊断疗效标准[S].北京:中国医药科技出版社,1994:19.
[9]邵肖梅,叶鸿瑁,丘小汕.实用儿科学[M].4版.北京:人民卫生出版社,2011:340-347.
[10]陈娇,钱晓明,任艺,等.MEWS评分、SIRS评分和APACHEⅡ评分对急诊颅脑外伤患者预后评估的对比研究[J].临床急诊杂志,2013,14(11):528-531.
[11]PASHA Y Z,AHMADPOURKACHO M,BEHMADI R,et al.3-Day versus 5-Day Course of Intravenous Antibiotics for Suspected Early Onset Neonatal Sepsis:A Randomized Controlled Trial[J].Iranian J Pediatrics,2014,24(6):673-678.
[12]徐艳,由军,毛春梅,等.新生儿败血症的临床特征、病原菌分布及耐药特点分析[J].哈尔滨医科大学学报,2016,50(2):156-158.
[13]唐莲,王三南,翁小红,等.利奈唑胺治疗新生儿败血症的疗效及对血小板的影响[J].药物不良反应杂志,2016,18(2):99-104.
[14]郭大斌,陈丽,雷永珍,等.大青龙汤联合西药治疗败血症的临床研究[J].中华中医药学刊,2014,32(5):1216-1218.
[15]戴琪,周元科,黄婕,等.大青龙汤方中桂枝-生姜药对的超临界CO2萃取物的血清药化学研究[J].湖北中医药大学学报,2014,16(3):52-56.
[16]肖佩玉,万正兰,黄际薇.大青龙汤对流感病毒感染小鼠血清与肺组织中免疫因子的影响研究[J].中华医院感染学杂志,2016,26(3):537-539.
[17]马劲夫,张纪元,周银苹,等.脓毒症患者CD14+CD16+单核细胞的作用探讨[J].中国急救复苏与灾害医学杂志,2013,8(8):717-720.
[18]廖崇伦.降钙素原和超敏C反应蛋白联合检测对新生儿败血症的诊断价值[J].新乡医学院学报,2013,30(3):218-220.
[19]王浩,陈志勇,汪文娟.TNF-α和IL-10在小儿败血症预后判断中的应用价值[J].中国卫生检验杂志,2013,23(3):706-707.