目的 探讨注射用多黏菌素E甲磺酸钠联合血必净注射液治疗脓毒症的疗效。方法 选取2021年3月—2023年2月在重庆大学附属涪陵医院ICU接受治疗的104例脓毒症患者作为研究对象。按随机数字表法将104例患者分为对照组和治疗组，各52例。对照组静脉滴注血必净注射液，100 mL血必净注射液溶入100 mL 0.9%氯化钠注射液，3次/d。治疗组在对照组治疗的基础上静脉注射注射用多黏菌素E甲磺酸钠，2.5 mg/kg，分2～4次给药，最大剂量不超过5 mg/kg。治疗期间若发生肾损伤患者，剂量减少为每日所需剂量一半，注射频率为1次/12 h。两组均治疗7～10 d。比较两组临床疗效、病情程度、血清炎症因子。结果 治疗后，治疗组总有效率达到92.31%，对照组总有效率为76.92%，治疗组总有效率明显高于对照组（P＜0.05）。治疗后，两组急性生理与慢性健康（APACHE Ⅱ）评分、序贯器官衰竭评估（SOFA）评分均显著降低（P＜0.001）；并且治疗组APACHE Ⅱ评分、SOFA评分低于对照组（P＜0.05）。治疗后，两组血清C反应蛋白（CRP）、降钙素原（PCT）、白细胞介素-6（IL-6）水平均显著降低（P＜0.001）；治疗组血清炎症因子水平均低于对照组（P＜0.05）。治疗期间，治疗组肾损伤发生率高于对照组（P＜0.05）。结论 注射用多黏菌素E甲磺酸钠联合血必净注射液治疗脓毒症能提高抗菌疗效，可明显改善病情，减轻机体炎症反应，但在治疗期间会增加肾损伤发生风险，建议在治疗过程中对患者进行肾功能监测。

Objective To investigate the efficacy of Colistimethate Sodium for injection combined with Xuebijing Injection in treatment of sepsis. Methods Patients (104 cases) with sepsis in ICU of Fuling Hospital Affiliated to Chongqing University from March 2021 to February 2023 were divided into control and treatment groups using the random number table method, and each group had 52 cases. Patients in the control group were iv administered with Xuebijing Injection, 100 mL added into 0.9% sodium chloride injection 100 mL, three times daily. Patients in the treatment group were iv administered with Colistimethate Sodium for injection on the basis of the control group, 2.5 mg/kg, the dosage was divided into 2 to 4 doses, with the maximum dose not exceeding 5 mg/kg, in patients with kidney injury during treatment, the dose was reduced to half of the required daily dose, and the injection frequency was once per 12 h. Patients in two groups were treated for 7 to 10 d. The clinical efficacies, state of illness, and serum inflammatory factors were compared between two groups. Results After treatment, the total effective rate of the treatment group reached 92.31%, the total effective rate of the control group was 76.92%, and the total effective rate of the treatment group was higher than that of the control group (P < 0.05). After treatment, APACHE Ⅱ score and SOFA score were significantly decreased in two groups (P < 0.05), and APACHE Ⅱ scores and SOFA scores in the treatment group were lower than those in the control group (P < 0.05). After treatment, the serum levels of CRP, PCT, and IL-6 were significantly decreased in two groups (P < 0.05), and the serum inflammatory factors levels in treatment group were lower than those in control group (P < 0.05). The incidence of kidney injury in the treatment group was higher than that in the control group (P < 0.05). Conclusion Colistimethate Sodium for injection combined with Xuebijing Injection in treatment of sepsis can improve antibacterial effect, significantly improve the condition and reduce the inflammatory response of the body, but it will increase the risk of kidney injury during treatment. It is recommended to monitor the kidney function during treatment.

R977

重庆市自然科学基金资助项目（cstc2021jcyj-msxmX0628）；重庆市卫计委中医药科研项目（2023WSJK139）