抗菌药物配合氯吡格雷治疗老年脑卒中合并肺部感染的疗效及对患者免疫功能的影响
|
摘要
目的评价抗菌药物配合氯吡格雷治疗老年脑卒中合并肺部感染的疗效及对患者免疫功能的影响。方法根据随机数表法将2015年1月-2016年12月医院接诊的102例老年脑卒中合并肺部感染患者分为两组。对照组51例,单用抗菌药物治疗;联合组51例,抗菌药物与氯吡格雷联用治疗。比较两组患者临床疗效、症状改善时间及用药安全性指标,并观察患者治疗前和治疗2周后免疫功能、炎性因子白介素-6(IL-6)、高敏C-反应蛋白(hs-CRP)、P-选择素(P-selectin)变化。结果联合组患者治疗后显效25例,有效22例,无效4例优于对照组(Z=-3.872,P=0.008);肺部啰音及咳嗽消失时间、体温恢复正常时间较对照组短(P<0.05);联合组治疗2周后T淋巴细胞亚群CD4+、CD4+/CD8+水平较对照组高,CD8+水平较对照组低,差异有统计学意义(P<0.05);IL-6、hs-CRP、P-selectin水平低于对照组(P<0.05);联合组不良反应发生率3.92%(2/51)略低于对照组7.84%(4/51),但差异无统计学意义。结论给予老年脑卒中合并肺部感染患者抗菌药物配合氯吡格雷治疗疗效确切,有助于提高其细胞免疫功能,调节炎症因子,抑制病情进展,促进临床症状及体征快速缓解,且用药安全性较高。
OBJECTIVE To evaluate the effect of antibiotics combined with clopidogrel on treatment of elderly stroke patients complicated with pulmonary infection and observe the impact on immune function.METHODS A total of 102 elderly stroke patients complicated with pulmonary infection who were treated in the hospital from Jan 2015 to Dec 2016 were enrolled in the study and randomly divided into the control group with 51 cases and the combination group with 51 cases.The control group was treated with single antibiotics,while the combination group was treated with antibiotics combined with clopidogrel.The clinical curative effect,time of improvement of symptoms and indicators of safe medication were compared between the two groups of patients,and the immune function and the levels of inflammatory factors interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)and P-selectin)were observed and compared between the two groups of patients before the treatment and after the treatment for 2 weeks.RESULTS There were 25 patients who were markedly effective,22 patients who were effective and 4 patients who were ineffective in the combination group after the treatment,and the curative effect of the combination group was significantly better than that of the control group(Z=-3.872,P=0.008).The time of disappearance of pulmonary rales and cough and time of recovery of body temperature were significantly shorter in the combination group than in the control group(P<0.05).The levels of T lymphocyte subsets CD4+and CD4+/CD8+of the combination group were significantly higher than those of the control group after the treatment for 2 weeks,while the CD8+level of the combination group was significantly lower than that of the control group(P<0.05);the levels of IL-6,hs-CRP and P-selectin of the combination group were significantly lower than those of the control group(P<0.05);the incidence of adverse reactions of the combination group was 3.92%(2/51),lower than 7.84%(4/51)of the control group,and there was no significant difference.CONCLUSION The antibiotics combined with clopidogrel can achieve remarkable effect on treatment of the elderly stroke patients complicated with pulmonary infection,improve the cellular immune function,regulate the inflammatory factors,inhibit the progression of disease and promote the rapid recovery of clinical symptoms and signs,with the safety high.
OBJECTIVE To evaluate the effect of antibiotics combined with clopidogrel on treatment of elderly stroke patients complicated with pulmonary infection and observe the impact on immune function.METHODS A total of 102 elderly stroke patients complicated with pulmonary infection who were treated in the hospital from Jan 2015 to Dec 2016 were enrolled in the study and randomly divided into the control group with 51 cases and the combination group with 51 cases.The control group was treated with single antibiotics,while the combination group was treated with antibiotics combined with clopidogrel.The clinical curative effect,time of improvement of symptoms and indicators of safe medication were compared between the two groups of patients,and the immune function and the levels of inflammatory factors interleukin-6(IL-6),high-sensitivity C-reactive protein(hs-CRP)and P-selectin)were observed and compared between the two groups of patients before the treatment and after the treatment for 2 weeks.RESULTS There were 25 patients who were markedly effective,22 patients who were effective and 4 patients who were ineffective in the combination group after the treatment,and the curative effect of the combination group was significantly better than that of the control group(Z=-3.872,P=0.008).The time of disappearance of pulmonary rales and cough and time of recovery of body temperature were significantly shorter in the combination group than in the control group(P<0.05).The levels of T lymphocyte subsets CD4+and CD4+/CD8+of the combination group were significantly higher than those of the control group after the treatment for 2 weeks,while the CD8+level of the combination group was significantly lower than that of the control group(P<0.05);the levels of IL-6,hs-CRP and P-selectin of the combination group were significantly lower than those of the control group(P<0.05);the incidence of adverse reactions of the combination group was 3.92%(2/51),lower than 7.84%(4/51)of the control group,and there was no significant difference.CONCLUSION The antibiotics combined with clopidogrel can achieve remarkable effect on treatment of the elderly stroke patients complicated with pulmonary infection,improve the cellular immune function,regulate the inflammatory factors,inhibit the progression of disease and promote the rapid recovery of clinical symptoms and signs,with the safety high.
引文
[1]冯雪华,王金光,丁健,等.急性缺血性脑卒中患者肺部感染对病情影响的研究[J].中华医院感染学杂志,2015,25(16):3726-3728.
[2]Stearns SC,Bemard SL,Fasiek SB,et al.The economic implications of self-care:the effect of lifestyle,functional adaptations,and medical self-care among a national sample of Medicare beneficiaries[J].Am J Public Health,2014,90(10):1608-1612.
[3]洪霞,刘国韬,袁衬容.氯吡格雷联合阿司匹林治疗急性脑卒中的效果分析[J].国际医药卫生导报,2014,20(12):1752-1755.
[4]宋海英,牛向宏.阿司匹林在有脑出血史缺血性脑卒中复发患者中的预防应用[J].湖南师范大学学报(医学版),2016,13(4):133-135.
[5]凌东进,施天生,陈中书,等.痰热清注射液联合抗生素治疗肺切除术后肺部感染疗效观察[J].中国中医急症,2016,25(10):1976-1978.
[6]饶明俐.《中国脑血管病防治指南》摘要(四)[J].中风与神经疾病杂志,2006,23(2):132-136.
[7]侍永伟,周仁华,徐建红,等.阿司匹林联合氯吡格雷治疗对急性缺血性脑卒中患者血小板聚集率的影响[J].血栓与止血学,2017,23(3):379-381.
[8]李春华,刘蕾.微生态制剂协同抗生素对ICU重症肺感染的疗效观察[J].中国微生态学杂志,2015,27(11):1316-1318.
[9]徐大飞,李凯,陈海波.氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的临床疗效和安全性[J].海南医学院学报,2014,20(9):1282-1285,1288.
[10]耿亚兰.氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床研究[J].中国临床药理学杂志,2016,32(24):2215-2217,2221.
[11]段发亮,黄从刚,倪厚杰,等.阿司匹林联合氯吡格雷治疗缺血性脑卒中的疗效及对血小板聚集率的影响[J].中国临床神经外科杂志,2017,22(7):470-472.
[12]龚贵香,汤健.缺血性脑卒中二级预防中阿司匹林与氯吡格雷的不良反应[J].中国实用神经疾病杂志,2016,19(4):118-119.
[13]路燕.阿司匹林联合氯吡格雷治疗进展性脑卒中的疗效研究[J].现代诊断与治疗,2017,28(12):2194-2195.
[14]张英,何世铭,廖维靖,等.作业疗法结合肌电生物反馈疗法对脑卒中偏瘫患者上肢功能及日常生活活动能力的影响[J].中华物理医学与康复杂志,2012,34(3):170-171.
[15]薛艳玲.阿司匹林联合氯吡格雷治疗轻型缺血性脑卒中100例的疗效及安全性[J].中国实用医刊,2017,44(6):96-98.
[16]孙宏,尚莉莉,蔡国锋,等.宣肺固金汤对脑卒中后肺感染患者白细胞介素及血液流变学的影响[J].西部中医药,2017,30(11):100-102.
[17]李万春,赖学章,孟晏莉.脾多肽注射液对脑卒中合并肺感染患者疗效及对血清中IL-18和IL-35的影响[J].中国老年学杂志,2015,35(16):4531-4532.
[18]De Lorenzo RJ,Sun DA,Blair RE,et al.An in vitro model of stroke-induced epilepsy:elucidation of the roles of glutamate and calcium in the induction and maintenance of stroke-induced epileptogenesis[J].Int Rev Neurobiol,2014,81(26):59-84.
[19]王坤,段毅,王军英,等.阿司匹林联合氯吡格雷治疗对缺血性脑卒中病人神经功能及血小板聚集率的影响[J].中西医结合心脑血管病杂志,2017,15(17):2207-2209.
[20]田美丽,刘焕乐.阿司匹林或氯吡格雷抵抗对急性冠状动脉综合征老年患者心血管不良事件的影响[J].中国循环杂志,2017,32(2):141-144.
[2]Stearns SC,Bemard SL,Fasiek SB,et al.The economic implications of self-care:the effect of lifestyle,functional adaptations,and medical self-care among a national sample of Medicare beneficiaries[J].Am J Public Health,2014,90(10):1608-1612.
[3]洪霞,刘国韬,袁衬容.氯吡格雷联合阿司匹林治疗急性脑卒中的效果分析[J].国际医药卫生导报,2014,20(12):1752-1755.
[4]宋海英,牛向宏.阿司匹林在有脑出血史缺血性脑卒中复发患者中的预防应用[J].湖南师范大学学报(医学版),2016,13(4):133-135.
[5]凌东进,施天生,陈中书,等.痰热清注射液联合抗生素治疗肺切除术后肺部感染疗效观察[J].中国中医急症,2016,25(10):1976-1978.
[6]饶明俐.《中国脑血管病防治指南》摘要(四)[J].中风与神经疾病杂志,2006,23(2):132-136.
[7]侍永伟,周仁华,徐建红,等.阿司匹林联合氯吡格雷治疗对急性缺血性脑卒中患者血小板聚集率的影响[J].血栓与止血学,2017,23(3):379-381.
[8]李春华,刘蕾.微生态制剂协同抗生素对ICU重症肺感染的疗效观察[J].中国微生态学杂志,2015,27(11):1316-1318.
[9]徐大飞,李凯,陈海波.氯吡格雷联合阿司匹林治疗进展性缺血性脑卒中的临床疗效和安全性[J].海南医学院学报,2014,20(9):1282-1285,1288.
[10]耿亚兰.氯吡格雷片联合阿司匹林肠溶片治疗急性缺血性脑卒中的临床研究[J].中国临床药理学杂志,2016,32(24):2215-2217,2221.
[11]段发亮,黄从刚,倪厚杰,等.阿司匹林联合氯吡格雷治疗缺血性脑卒中的疗效及对血小板聚集率的影响[J].中国临床神经外科杂志,2017,22(7):470-472.
[12]龚贵香,汤健.缺血性脑卒中二级预防中阿司匹林与氯吡格雷的不良反应[J].中国实用神经疾病杂志,2016,19(4):118-119.
[13]路燕.阿司匹林联合氯吡格雷治疗进展性脑卒中的疗效研究[J].现代诊断与治疗,2017,28(12):2194-2195.
[14]张英,何世铭,廖维靖,等.作业疗法结合肌电生物反馈疗法对脑卒中偏瘫患者上肢功能及日常生活活动能力的影响[J].中华物理医学与康复杂志,2012,34(3):170-171.
[15]薛艳玲.阿司匹林联合氯吡格雷治疗轻型缺血性脑卒中100例的疗效及安全性[J].中国实用医刊,2017,44(6):96-98.
[16]孙宏,尚莉莉,蔡国锋,等.宣肺固金汤对脑卒中后肺感染患者白细胞介素及血液流变学的影响[J].西部中医药,2017,30(11):100-102.
[17]李万春,赖学章,孟晏莉.脾多肽注射液对脑卒中合并肺感染患者疗效及对血清中IL-18和IL-35的影响[J].中国老年学杂志,2015,35(16):4531-4532.
[18]De Lorenzo RJ,Sun DA,Blair RE,et al.An in vitro model of stroke-induced epilepsy:elucidation of the roles of glutamate and calcium in the induction and maintenance of stroke-induced epileptogenesis[J].Int Rev Neurobiol,2014,81(26):59-84.
[19]王坤,段毅,王军英,等.阿司匹林联合氯吡格雷治疗对缺血性脑卒中病人神经功能及血小板聚集率的影响[J].中西医结合心脑血管病杂志,2017,15(17):2207-2209.
[20]田美丽,刘焕乐.阿司匹林或氯吡格雷抵抗对急性冠状动脉综合征老年患者心血管不良事件的影响[J].中国循环杂志,2017,32(2):141-144.