目的 探讨清开灵注射液联合亚胺培南西司他丁钠治疗老年重症肺炎的临床疗效。方法 选取2017年1月—2020年6月在濮阳市油田总医院进行治疗的62例老年重症肺炎患者为研究对象，依据就诊顺序分为对照组和治疗组，每组各31例。对照组静脉滴注注射用亚胺培南西司他丁钠，20 mL/次同生理盐水100 mL配伍，每隔8 h静脉滴注1次；治疗组在对照组基础上给予清开灵注射液20 mL同生理盐水100 mL配伍，每隔12 h静脉滴注1次。两组均进行10 d治疗后进行效果比较。观察两组的临床疗效，比较两组临床症状恢复时间、肺功能指标、血气分析指标和血清学指标的变化情况。结果 治疗后，治疗组总有效率96.77%显著高于对照组的80.65%（P<0.05）。经治疗，治疗组患者体温恢复时间、咳嗽消失时间、呼吸困难消失时间、肺部啰音消失时间显著短于对照组（P<0.05）。治疗后，两组第1秒用力呼气量（FEV1）、用力肺活量（FVC）、呼气流量峰值（PEF）均较治疗前显著增加（P<0.05）；治疗后，治疗组这些肺功能指标显著高于对照组（P<0.05）。经治疗，两组氧分压（pO₂）、氧合指数（pO₂/FiO₂）均显著升高，而二氧化碳分压（pCO₂）均显著降低（P<0.05）；治疗后，治疗组这些血气分析指标优于对照组（P<0.05）。经治疗，两组血清超敏C反应蛋白（hs-CRP）、降钙素原（PCT）、可溶性髓系细胞触发受体（sTREM-1）、高迁移率族蛋白1（HMGB1）均较治疗前显著降低，而SP蛋白（SP-D）、可溶性尿激酶型纤溶酶原激活物受体（suPAR）均显著升高（P<0.05）；治疗后，治疗组这些血清学指标显著优于对照组（P<0.05）。结论 清开灵注射液联合亚胺培南西司他丁钠治疗老年重症肺炎具有较好的临床疗效，可有效改善患者肺功能和血气分析指标，促进机体细胞因子水平改善，具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Qingkailing Injection combined with imipenem and cilastatin sodium in treatment of severe pneumonia in the elderly. Methods 62 elderly patients with severe pneumonia who were treated in Puyang Oilfield General Hospital from January 2017 to June 2020 were selected as study subjects, and they were divided into control group and treatment group according to the order of treatment, with 31 patients in each group. Patients in the control group were iv administered with Imipenem and Cilastatin Sodium for injection, 20 mL/time was compatible with 100 mL normal saline, and intravenous infusion was performed once every 8 h. Patients in the treatment group were iv administered with Qingkailing Injection on the basis of the control group, 20 mL was compatible with 100 mL normal saline, and intravenous infusion was performed once every 12 h. The effects of the two groups were compared after treatment for 10 days. The clinical efficacy of the two groups was observed, and the changes of clinical symptom recovery time, lung function indexes, blood gas analysis indexes and serological indexes in the two groups were compared. Results After treatment, the total effective rate of 96.77% in the treatment group was significantly higher than 80.65% in the control group (P<0.05). After treatment, the temperature recovery time, cough extinction time, dyspnea extinction time and lung rhonchus extinction time in the treatment group were significantly shorter than those in the control group (P<0.05). After treatment, forced expiratory volume (FEV1), forced vital capacity (FVC) and peak expiratory flow (PEF) in both groups were significantly higher than those before treatment (P<0.05). After treatment, these lung function indexes in the treatment group were significantly higher than those in the control group (P<0.05). After treatment, oxygen partial pressure (pO₂) and oxygenation index (pO₂/FiO₂) were significantly increased in both groups, while carbon dioxide partial pressure (pCO₂) was significantly decreased in both groups (P<0.05). After treatment, the blood gas analysis indexes of the treatment group were better than those of the control group (P<0.05). After the treatment, serum hypersensitive C-reactive protein (hs-CRP), calcitonin (PCT), soluble myeloid cells trigger receptor (sTREM-1) and high mobility group protein 1 (HMGB1) in two groups was significantly reduced, but SP protein (SP-D), soluble urokinase type fibrinolytic enzyme receptor (suPAR) was significantly increased (P<0.05). After treatment, these serological indicators in the treatment group were significantly better than those in the control group (P<0.05). Conclusion Qingkailing Injection combined with imipenem and cilastatin sodium has good clinical effect in treatment of severe pneumonia in the elderly, and can effectively improve patients' lung function and blood gas analysis indicators, and promote the improvement of the body's cytokine levels, which has certain clinical application value.

R974

四川省中医药科学技术研究专项项目（20160086）