目的 探究地塞米松联合注射用头孢哌酮钠舒巴坦钠对儿童脓毒症的疗效及对患儿血清降钙素原（PCT）、可溶性白细胞分化抗原14亚型（Presepsin）及N末端脑钠肽前体（NT-proBNP）水平的影响。方法 前瞻性选取江苏省淮安市妇幼保健院（淮安市儿童医院）2019年4月—2021年4月收治的脓毒症患儿110例，随机分为对照组（n=55）和试验组（n=55）。对照组患儿给予注射用头孢哌酮钠舒巴坦钠治疗，按40 mg·kg^-1剂量取注射用头孢哌酮钠舒巴坦钠溶于50 mL 0.9%氯化钠注射液中静脉滴注给药，12 h给药1次，连续用药7 d。试验组患儿在对照组基础上加用注射用地塞米松磷酸钠治疗，5 mg注射用地塞米松磷酸钠溶于5%葡萄糖注射液5 mL中静脉推注，每天1次，连续治疗4 d后停药，其他药物同对照组连续治疗7 d。比较两组患儿临床疗效，比较两组患儿治疗前后急性生理与慢性健康评分（APACHE-Ⅱ）及血清PCT、Presepsin、NT-proBNP水平，比较治疗前后两组患儿肝肾功能指标尿素氮（BUN）、肌酐（Scr）、天冬氨酸氨基转移酶（AST）及丙氨酸氨基转移酶（ALT）水平及不良反应发生情况。结果 治疗后，对照组总有效率为78.18%，试验组总有效率为94.55%，较对照组明显升高（P<0.05）。与治疗前比较，治疗后两组患儿APACHE-Ⅱ评分及血清PCT、Presepsin、NT-proBNP、BUN、Scr、AST和ALT水平均明显降低（P<0.05），且与对照组比较，试验组各项指标降低更显著（P<0.05）。两组患儿不良反应总发生率比较差异无统计学意义（P>0.05）。结论 地塞米松联合注射用头孢哌酮钠舒巴坦钠治疗儿童脓毒症可有效降低PCT、Presepsin、NT-proBNP水平，减轻炎症反应，提高肝肾功能，改善临床症状，安全有效。

Objective To investigate the effect of dexamethasone combined with Cefoperazone Sodium and Sulbactam Sodium for Injection on children's sepsis and the levels of serum procalcitonin (PCT), soluble leukocyte differentiation antigen 14 subtype (Presepsin) and N-terminal brain natriuretic peptide precursor (NT-proBNP). Methods Ttotal 110 children with sepsis treated in Huai'an Women and Chilldren Health Hospital of Jiangsu Province (Huai'an Chilldren's Hospital) from April 2019 to April 2021 were prospectively selected and randomly divided into control group (n=55) and experimental group (n=55). The children in the control group were treated with Cefoperazone Sodium and Sulbactam Sodium for Injection. According to the dose of 40 mg·kg^-1, Cefoperazone Sodium and Sulbactam Sodium for Injection were dissolved in 50 mL of 0.9% Sodium Chloride Injection and administered intravenously once for 12 h for seven days. The children in the experimental group were treated with Dexamethasone Sodium Phosphate for Injection (soluble in glucose injection) on the basis of the control group, and injected intravenously for 5 mg each time once a day, the drug was stopped after continuous treatment for four days, and other drugs were continuously treated for seven days with the control group. The clinical effects of the two groups were compared, the acute physiology and chronic health scores (APACHE-Ⅱ) and the levels of serum PCT, Presepsin and NT-proBNP before and after treatment were compared. The levels of serum urea nitrogen (BUN), creatinine (Scr), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were compared between the two groups before and after treatment. The adverse reactions of the two groups were recorded. Results After treatment, the total effective rate was 78.18% in the control group and 94.55% in the experimental group which was higher than that of the control group (P < 0.05). Compared with before treatment, the APACHE-Ⅱ score and the levels of serum PCT, Presepsin, NTproBNP, BUN, Scr, AST and ALT in the two groups after treatment were significantly lower (P < 0.05), and the indexes in the experimental group were significantly lower than those in the control group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups. Conclusion Dexamethasone combined with Cefoperazone Sodium and Sulbactam Sodium for Injection can effectively reduce the levels of PCT, Presepsin and NT-proBNP, reduce inflammatory reaction, improve liver and kidney function and improve clinical symptoms in children with sepsis.

R985

江苏省卫生健康委科研项目（LGY2018044）