目的 分析讨论多粘菌素在VAP治疗中的临床效果评价,以及对患者TNF-α表达水平的影响.方法 研究选取本院呼吸机相关性肺炎患者104例进行分析.根据患者治疗情况分为观察组50例,对照组54例.综合判断比较临床疗效以及治疗前后的TNF-α水平变化等.研究使用SPSS 20.0行统计分析.结果 本研究中50例观察组患者以及54例对照组患者基本情况的组间差异无统计学意义,可比性良好.随访比较两组患者治疗后4d和14d的疗效情况,提示治疗4d随访观察组和对照组的显效率和无效率差别显著,观察组的显效率为78.00％,无效率仅为12.00％;对照组的显效率为53.70％,无效率为42.59％;差别有统计学意义,P＜0.05.治疗14d随访则见两组患者的痊愈率差别显著,观察组的痊愈率达到了20.00％,对照组仅为5.55％,P＜0.05;但是显效和无效率差别未见统计学意义.治疗后14d的TNF-α水平比较可见两组患者TNF-α水平均较治疗前有显著减低,P＜0.05;同时观察组治疗后的水平又显著低于对照组,两组治疗后的水平分别为133.87±12.08 pg/mL和165.87±11.24 pg/mL,P＜0.05.结论 多粘菌素治疗短期内可以提高显效率,治疗14d可显著提高患者的痊愈率.TNF-α是炎症反应过程中出现最早、最重要的炎性介质之一,从这个角度来看治疗后观察组的TNF-α水平更低表明了炎症状态控制水平在观察组更优.%Objective To evaluate the clinical efficacy of polymyxin in VAP therapy and the effect of TNF-a on the expression of TNF-α in patients.Methods 104 cases of ventilator-associated pneumonia were selected and analyzed.According to the treatment,patients were divided into observation group(50 cases) and control group (54 cases).Comprehensive judgments compared to clinical efficacy and changes in TNF-α levels before and after treatment.The study was performed using SPSS 20.0 line of statistical analysis.Results There was no statistically significant difference between observation group and control group.The comparability was good.The results showed that the effective rate and inefficiency rate were significantly different between observation group and control group 4 days and 14 days after treatment.The effective rate of the observation group was 78.00％,but the efficiency was only 12.00 ％.The effective rate of the control group was 53.70％,the inefficiency rate was 42.59％,and the difference was statistically significant (P ＜0.05).The cure rates were significantly different between the two groups,which was 20.00％ in observation group and only 5.55 ％,in control group (P ＜ 0.05).The difference between markedly and ineffective was not statistically significant.The levels of TNF-α in the two groups were significantly lower than those before treatment(P ＜ 0.05).At the same time,the level of TNF-α in observation group was significantly lower than that in control group,which were 133.87 ± 12.08 pg/mL and 165.87 ± 11.24 pg/mL,respectively (P ＜0.05).Conclusion The treatment of polymyxin can improve the effective rate in the short term,and the cure rate can be improved significantly for 14 days.TNF-α is one of the earliest and most important inflammatory mediators in the inflammatory response.From this point of view,the lower level of TNF-α in observation group after treatment indicates that the level of inflammation in control group is better than that in the observation group.
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