目的 观察盐酸溴己新联合利奈唑胺治疗肺结核继发重症肺炎患者中的临床疗效。方法 选取2023年10月—2025年9月沧州市第三医院收治的120例肺结核继发革兰阳性菌重症肺炎患者，根据治疗方式的不同分为对照组和治疗组，每组各60例。对照组静脉滴注利奈唑胺葡萄糖注射液，600 mg/次，12小时1次。治疗组患者在对照组治疗基础上联合静脉滴注盐酸溴己新注射液，4 mg/次，2次/d。两组患者均连续治疗2周。观察两组临床疗效、病原菌清除和临床症状改善情况，比较两组血清C反应蛋白（CRP）、降钙素（PCT）、肿瘤坏死因子-α（TNF-α）、白细胞计数（WBC）。结果 治疗后，治疗组和对照组的总有效率分别是98.33%、83.33%，两组病原菌清除率分别是91.67%、66.67%，治疗组总有效率和病原菌清除率均高于对照组（P＜0.05）。治疗组患者咳嗽咳痰消退时间、退热时间、痰菌转阴时间均较对照组短（P＜0.05）。治疗后，两组CRP、PCT、TNF-α、WBC水平均较同组治疗前显著降低（P＜0.05）；治疗后，治疗组CRP、PCT、TNF-α、WBC水平低于对照组（P＜0.05）。结论 盐酸溴己新联合利奈唑胺治疗肺结核继发重症肺炎患者可显著提高总有效率及病原菌清除率，加快患者临床症状缓解，改善炎症反应，且安全性良好。

Objective To observe the clinical efficacy of hydrochloride bromhexine combined with linezolid in treatment of patients with severe secondary pneumonia secondary to pulmonary tuberculosis. Methods A total of 120 patients with severe secondary pneumonia secondary to pulmonary tuberculosis and treated at Cangzhou Third Hospital from October 2023 to September 2025 were selected. They were divided into control group and treatment group based on different treatment methods, with 60 cases in each group. Patients in control group received intravenous infusion of Linezolid and Glucose Injection at 600 mg/time, once every 12 h. Patients in treatment group received intravenous infusion of Bromhexine Hydrochloride Injection at 4 mg/time, twice daily, in addition to the treatment in control group. Both groups were treated continuously for 2 weeks. The clinical efficacy, clearance of pathogenic bacteria, and improvement of clinical symptoms in two groups were observed, and the serum C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor-α (TNF-α), and white blood cell count (WBC) of two groups were compared. Results After treatment, the total effective rates of treatment group and the control group were 98.33% and 83.33%, respectively, and the clearance rates of pathogenic bacteria in two groups were 91.67% and 66.67%, respectively. The total effective rate and the clearance rate of pathogenic bacteria in treatment group were both higher than those in control group (P < 0.05). The duration of cough and expectoration subsiding, the time of fever reduction, and the time of negative sputum culture in treatment group were shorter than those in control group (P < 0.05). After treatment, the levels of CRP, PCT, TNF-α, and WBC in two groups were significantly lower than those before treatment in same group (P < 0.05). After the treatment, the levels of CRP, PCT, TNF-α, and WBC in treatment group were lower than those in control group (P < 0.05). Conclusion The combination of hydrochloride bromhexine and linezolid in treatment of patients with severe secondary pneumonia secondary to pulmonary tuberculosis can significantly increase the total effective rate and the clearance rate of pathogenic bacteria, accelerate the alleviation of patients' clinical symptoms, improve the inflammatory response, which has good safety.

沧州市重点研发计划指导项目（222106069）