Objective: To evaluate the prognostic value of acute physiology and chronic health status score (APACHE Ⅱ) and chronic obstructive pulmonary disease (COPD) and bronchial asthma physiology score (CAPS) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure. Methods: From February 2016 to January 2018, 139 patients with AECOPD complicated with type II respiratory failure in the Second People's Hospital of Lishui were selected.APACHE Ⅱ and CAPS were scored on the day of admission.The patients were divided into survival group (97 cases) and death group (42 cases) according to their clinical prognosis. Results: The APACHE Ⅱ score and CAPS score of the death group were significantly higher than those of the survival group at admission [(20.15±3.27)points vs. (23.84±2.18)points, (30.85±3.44)points vs. (34.46±5.72)points, t=5.601, 4.596, all P<0.05]. The higher the score of APACHE Ⅱ and CAPS, the higher the fatality rate of patients(69.77% vs. 12.50%, 58.33% vs. 15.38%)(χ²=46.190, 27.490, all P<0.05). The AUC of APACHE Ⅱ score predicted death in patients with AECOPD and respiratory failure was 0.916 with high accuracy.The AUC of CAPS score predicted the death rate of patients with AECOPD combined with respiratory failure was 0.846, and the prediction had certain accuracy. Conclusion APACHE Ⅱ score and CAPS score have good clinical application value in evaluation of prognosis of patients with AECOPD complicated with respiratory failure.APACHE Ⅱ score is more effective in predicting the death of patients.The combination of APACHE Ⅱ score and CAPS score can be considered in clinical application, which can help doctors to draw up the best treatment plan and improve the clinical prognosis of patients.

Objective:To investigate the clinical effects of moxifloxacin combined with biapenem on controlling inflammatory responses and improving immune function in older adult patients with severe pneumonia.Methods:120 older adult patients with severe pneumonia, who received treatment in the Second People's Hospital of Lishui from February 2017 to March 2020, were included in this study. They were randomly assigned to receive either biapenem (control group, n = 55) or moxifloxacin combined with biapenem (observation group, n = 65) for 7 days. Inflammatory response control, immune function improvement, and adverse reactions were assessed in each group after treatment. Results:After treatment, levels of interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP) and procalcitonin (PCT) in the observation group were (24.51 ± 4.24) ng/L, (12.51 ± 3.15) mg/L and (4.62 ± 1.05) μg/L, respectively, which were significantly lower than those in the control group [(48.74 ± 4.67) ng/L, (26.80 ± 4.24) mg/L, (8.92 ± 1.10) μg/L, t = 29.77, 21.14, 21.87, all P < 0.001). The proportion of CD 3+ and CD 4+ cells and CD 4+ / CD 8+ ratio in the observation group were (63.27 ± 3.72)%, (39.97 ± 2.18)%, 1.79 ± 0.16, respectively, which were significantly higher than those in the control group [(55.58 ± 2.28)%, (35.18 ± 2.62)%, 1.41 ± 0.15, t = 17.08, 10.93, 13.34, all P < 0.001). Total effective rate was significantly higher in the observation group than in the control group [96.92% (63/65) vs. 83.64% (46/55), χ2 = 6.32, P < 0.05]. There was no significant difference in the incidence of adverse reactions between observation and control groups [10.77% (7/65) vs. 9.09% (5/55), χ2 = 0.09, P > 0.05]. Conclusion:Moxifloxacin combined with biapenem based on routine treatment for severe pneumonia in older adult patients can greatly strengthen anti-inflammatory effects, improve immune function, and enhance clinical efficacy without increasing adverse drug reactions.

Objective:To investigate the effects of ulinastatin combined with meropenem on immune function, interleukin 2(IL-2), interleukin 4(IL-4), interleukin-6(IL-6), interleukin 10(IL-10) and tumor necrosis factor (TNF-) levels in elderly patients with severe infection.Methods:From January 2016 to June 2018, 60 elderly patients with severe infections admitted to the Second People's Hospital of Lishui were randomly divided into control group(30 cases) and observation group(30 cases). The patients in the control group were treated with meropenem, while the patients in the observation group were treated with ulinastatin on the basis of the control group.Both two groups were treated for 14 days.The therapeutic effects, changes of T lymphocyte subsets, IL-2, IL-4, IL-6, IL-10 and TNF-levels, recovery time of gastrointestinal function and occurrence of systemic inflammatory response syndrome(SIRS) before and after treatment were compared between the two groups.Results:The total effective rate of the observation group(93.33%) was higher than that of the control group(66.67%)(χ 2=6.667, P<0.05). After treatment, CD 3+ [(64.38±3.19)%], CD 4+ [(40.39±2.35)%]and CD 4+/CD 8+ (1.65±0.19) in the observation group were higher than those in the control group[(58.94±3.56)%, (35.47±2.87)% and (1.34±0.14)]( t=6.233, 7.265, 3.834, all P<0.05). The serum levels of IL-2[(126.87±17.49)ng/L], IL-4[(8.98±2.14)g/L], IL-6[(176.89±23.1)ng/L], IL-10[(37.94±12.56)ng/L] and TNF-α[(163.45±17.96)ng/L]in the observation group were lower than those in the control group[(343.27±28.56)ng/L, (19.65±4.56) g/L, (346.37±38.98)ng/L, (83.21±18.56)ng/L and (254.37±23.45)ng/L]( t=35.392, 10.602, 20.476, 11.064, 16.860, all P<0.05). The recovery time of gastrointestinal function in the observation group[(5.31±1.29)d] was shorter than that in the control group[(6.97±1.43)d]( t=4.721, P<0.05), while the incidence of SIRS(13.33%) was lower than that in the control group(43.33%)(χ 2=6.648, P<0.05). Conclusion:Ulinastatin combined with meropenem is effective in the treatment of elderly patients with severe infection.It can improve the immune function of the patients, reduce the levels of IL-2, IL-4, IL-6, IL-10 and TNF-, and alleviate the inflammatory reaction.It is worthy of clinical reference.