目的 探究地塞米松聯(lián)合注射用頭孢哌酮鈉舒巴坦鈉對(duì)兒童膿毒癥的療效及對(duì)患兒血清降鈣素原（PCT）、可溶性白細(xì)胞分化抗原14亞型（Presepsin）及N末端腦鈉肽前體（NT-proBNP）水平的影響。方法 前瞻性選取江蘇省淮安市婦幼保健院（淮安市兒童醫(yī)院）2019年4月—2021年4月收治的膿毒癥患兒110例，隨機(jī)分為對(duì)照組（n=55）和試驗(yàn)組（n=55）。對(duì)照組患兒給予注射用頭孢哌酮鈉舒巴坦鈉治療，按40 mg·kg^-1劑量取注射用頭孢哌酮鈉舒巴坦鈉溶于50 mL 0.9%氯化鈉注射液中靜脈滴注給藥，12 h給藥1次，連續(xù)用藥7 d。試驗(yàn)組患兒在對(duì)照組基礎(chǔ)上加用注射用地塞米松磷酸鈉治療，5 mg注射用地塞米松磷酸鈉溶于5%葡萄糖注射液5 mL中靜脈推注，每天1次，連續(xù)治療4 d后停藥，其他藥物同對(duì)照組連續(xù)治療7 d。比較兩組患兒臨床療效，比較兩組患兒治療前后急性生理與慢性健康評(píng)分（APACHE-Ⅱ）及血清PCT、Presepsin、NT-proBNP水平，比較治療前后兩組患兒肝腎功能指標(biāo)尿素氮（BUN）、肌酐（Scr）、天冬氨酸氨基轉(zhuǎn)移酶（AST）及丙氨酸氨基轉(zhuǎn)移酶（ALT）水平及不良反應(yīng)發(fā)生情況。結(jié)果 治療后，對(duì)照組總有效率為78.18%，試驗(yàn)組總有效率為94.55%，較對(duì)照組明顯升高（P<0.05）。與治療前比較，治療后兩組患兒APACHE-Ⅱ評(píng)分及血清PCT、Presepsin、NT-proBNP、BUN、Scr、AST和ALT水平均明顯降低（P<0.05），且與對(duì)照組比較，試驗(yàn)組各項(xiàng)指標(biāo)降低更顯著（P<0.05）。兩組患兒不良反應(yīng)總發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。結(jié)論 地塞米松聯(lián)合注射用頭孢哌酮鈉舒巴坦鈉治療兒童膿毒癥可有效降低PCT、Presepsin、NT-proBNP水平，減輕炎癥反應(yīng)，提高肝腎功能，改善臨床癥狀，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

江蘇省衛(wèi)生健康委科研項(xiàng)目（LGY2018044）