目的 探讨参麦注射液联合头孢克肟治疗老年肺炎的临床疗效。方法 纳入2022年1月—2024年12月南阳医学高等专科学校第一附属医院收治的148例老年肺炎患者，按照随机数字表法分为对照组和治疗组，每组各74例。对照组口服头孢克肟分散片，0.1 g/次，2次/d。在此基础上，治疗组静脉滴注参麦注射液，100 mL加入5%葡萄糖注射液250 mL中充分稀释后使用，1次/d。疗程14 d。比较两组临床疗效、痰培养转阴率和典型表现消失时间，治疗前后血气分析指标[动脉血氧分压（pO₂）、二氧化碳分压（pCO₂）、氧合指数]、相关量表[肺炎医生报告结局量表（CAP-CRO）、CURB-65、肺炎胸片吸收评价量表（PCRAES）]评分及血清超氧化物歧化酶（SOD）、丙二醛（MDA）、降钙素原（PCT）、血管细胞黏附分子-1（VCAM-1）和全身炎症反应指数（SIRI）水平。结果 治疗组总有效率（94.59%）较对照组（83.78%）更高（P＜0.05）。治疗组痰培养转阴率（90.54%）较对照组（75.68%）更高（P＜0.05）。治疗组发热、胸闷痛、咳嗽和肺部啰音等各项典型表现消失时间短于对照组（P＜0.05）。治疗后，两组血气指标pO₂和氧合指数升高（P＜0.05），pCO₂降低（P＜0.05）；治疗组上述指标均优于对照组（P＜0.05）。治疗后，两组CAP-CRO、CURB-65、PCRAES评分均降低（P＜0.05）；治疗组上述评分均低于对照组（P＜0.05）。治疗后，两组血清SOD水平升高（P＜0.05），血清MDA、PCT、VCAM-1水平及SIRI均降低（P＜0.05）；治疗组上述指标均优于对照组（P＜0.05）。结论 参麦注射液联合头孢克肟治疗老年肺炎，能有效控制感染程度，抑制氧化损伤和炎症反应，进一步减轻患者肺部炎症及临床症状，利于呼吸功能好转及病情和预后改善。

Objective To explore the clinical efficacy of Shenmai Injection combined with cefixime in the treatment of elderly patients with pneumonia. Methods A total of 148 elderly patients with pneumonia admitted to the First Affiliated Hospital of Nanyang Medical College from January 2022 to December 2024 were enrolled and divided into a control group and a treatment group using the random number table method, with 74 cases in each group. Patients in the control group were po administered with Cefixime Dispersible Tablets at a dose of 0.1 g per time, twice daily. On the basis of the above regimen, patients in the treatment group were additionally given intravenous drip of Shenmai Injection: 100 mL of Shenmai Injection was fully diluted with 250 mL of 5% Glucose Injection for administration, once daily. The treatment course lasted 14 d. The two groups were compared in terms of clinical efficacy, sputum culture negative conversion rate, disappearance time of typical clinical manifestations; blood gas analysis indicators[arterial partial pressure of oxygen (pO₂), partial pressure of carbon dioxide (pCO₂), oxygenation index] before and after treatment; scores of related scales[Community-Acquired Pneumonia Clinician-Reported Outcome scale (CAP-CRO), CURB-65 scale, Pneumonia Chest Radiograph Absorption Evaluation Scale (PCRAES)]. As well as serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), procalcitonin (PCT), vascular cell adhesion molecule-1 (VCAM-1), and systemic inflammatory response index (SIRI). Results The total effective rate of the treatment group was significantly higher than that of the control group (94.59% vs 83.78%, P < 0.05). The sputum culture negative conversion rate in the treatment group was also superior to the control group (90.54% vs 75.68%, P < 0.05). The disappearance time of typical manifestations including fever, chest tightness and pain, cough and pulmonary rales in the treatment group was shorter than that in the control group (P < 0.05). After treatment, pO₂ and oxygenation index were elevated while pCO₂ was decreased in both groups (P < 0.05), with better improvements observed in the treatment group (P < 0.05). Post-treatment scores of CAP-CRO, CURB-65 and PCRAES were decreased in both groups (P < 0.05), and the scores of the treatment group were markedly lower (P < 0.05). Serum SOD levels increased, whereas serum MDA, PCT, VCAM-1 levels and SIRI declined in both groups after treatment (P < 0.05); the treatment group presented more favorable changes in all the above biomarkers (P < 0.05). Conclusion For elderly patients with pneumonia, the combination therapy of Shenmai Injection and cefixime can effectively control infection, alleviate oxidative damage and inflammatory response, further relieve pulmonary inflammation and clinical symptoms, facilitate the recovery of respiratory function, and improve disease condition and prognosis.

R974

河南省终身教育专项课题和课程开发立项项目（豫教[2023]70016）