目的 探讨胸腺肽联合头孢哌酮钠舒巴坦治疗呼吸机相关肺炎临床疗效。方法 选取十堰市太和医院2015年4月—2017年4月收治的呼吸机相关肺炎患者154例，随机分为对照组（77例）和治疗组（77例）。对照组患者静脉滴注注射用头孢哌酮钠舒巴坦钠，3 g加入100 mL生理盐水，1次/8 h。治疗组在对照组基础上静脉滴注注射用胸腺肽，80 mg加入500 mL生理盐水，1次/d。两组患者均治疗14 d。观察两组患者临床疗效，比较治疗前后两组患者临床症状消失时间、住院时间和啰音消失时间、体温、白细胞计数（WBC）、中性粒细胞比例（NEUT%）水平及血清降钙素原（PCT）、高敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）和外周血淋巴细胞水平。结果 治疗后，对照组和治疗组临床总有效率分别为71.43%和85.71%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组患者临床症状消失时间、住院时间和啰音消失时间均显著短于对照组（P<0.05）。治疗后，两组患者患者体温、WBC、NEUT%水平均明显降低（P<0.05）；且治疗组患者上述指标明显低于对照组（P<0.05）。治疗后，两组血清PCT、hs-CRP、IL-6水平显著降低（P<0.05）；且治疗组患者治疗后血清PCT、hs-CRP、IL-6水平明显低于对照组（P<0.05）。治疗后，治疗组外周血CD³⁺、CD⁴⁺T淋巴细胞、CD⁴⁺/CD⁸⁺水平明显升高（P<0.05），CD⁸⁺T淋巴细胞水平明显降低（P<0.05）；且治疗组患者治疗后上述外周血淋巴细胞水平明显好于对照组（P<0.05）。结论 胸腺肽联合头孢哌酮钠舒巴坦治疗呼吸机相关肺炎能有效缩短病程，改善血常规指标，提高免疫功能，具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of thymic peptide combined with cefoperazone sodium and sulbactam sodium in treatment of ventilator-associated pneumonia. Methods Patients (154 cases) with ventilator-associated pneumonia in Taihe Hospital from April 2015 to April 2017 were randomly divided into control (77 cases) and treatment (77 cases). Patients in the control group were iv administered with Cefoperazone Sodium and Sulbactam Sodium for injection, 3 g added into normal saline 100 mL, once every 8 h. Patients in the treatment group were iv administered with Thymopetidum for injection on the basis of the control group, 80 mg added into normal saline 500 mL, once daily. Patients in two groups were treated for 14 d. After treatment, the clinical efficacy was evaluated, and the disappearance time of clinical symptoms and pulmonary rales, the hospitalization time, temperature, WBC, NEUT%, the serum PCT, hs-CRP and IL-6, the peripheral blood lymphocyte levels in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups were 71.43% and 85.71% respectively, and there were differences between two groups (P < 0.05). After treatment, the disappearance time of clinical symptoms and pulmonary rales, the hospitalization time in the treatment group was significantly shorter than that in the control group (P < 0.05). After treatment, the temperature, WBC and NEUT% in two groups were significantly decreased (P < 0.05). And these indicators in the treatment group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the PCT, hs-CRP and IL-6 levels in two groups were significantly decreased (P < 0.05). And the PCT, hs-CRP and IL-6 levels in the treatment group after treatment were significantly lower than those in the control group (P < 0.05). After treatment, the CD³⁺, CD⁴⁺ and CD⁴⁺/CD⁸⁺ levels in two groups were significantly increased, but the CD⁸⁺ levels were significantly decreased (P < 0.05). And the peripheral blood lymphocyte levels in the treatment group after treatment were significantly better than those in the control group (P < 0.05). Conclusion Thymic peptide combined with cefoperazone sodium and sulbactam sodium in treatment of ventilator-associated pneumonia can effectively shorten disease course, improve blood routine indexes and immune function, which has a certain clinical application value.

湖北省自然科学基金资助项目（2010CDB09103）