美罗培南治疗重症肺炎36例

Evaluation of meropenem in 36 patients with severe pneumonia

目的评价美罗培南治疗重症肺炎的临床疗效及安全性。方法以36例重症肺炎患者为研究对象,给予美罗培南0.5或1g每8小时1次静脉滴脉,疗程为(10.5±3.5)d,观察重症肺炎患者体温变化,测定重症肺炎患者治疗前、后的血清超敏C反应蛋白(hsCRP)、血常规、动脉血氧分压(PaO2)及氧合指数(PaO2/FiO2),血清丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素氮(BUN)、肌酐(Cr),留取痰液进行痰培养检查,复查胸部CT;比较重症肺炎患者治疗前、后相关数值的差异,并观察美罗培南的不良反应。结果 5例重症肺炎患者死亡。31例重症肺炎患者应用美罗培南治疗后体温明显下降,体温降至正常时间平均为(3.2±1.3)d;重症肺炎患者治疗后血清超敏CRP浓度(6.7±2.5)mg/L,明显低于治疗前(70.3±15.2)mg/L,治疗后外周血白细胞总数(7.4±2.1)×109/L,明显低于治疗前(15.8±4.7)×109/L,治疗后PaO2(81.5±15.5)mm-Hg,明显高于治疗前(46.2±11.9)mmHg,治疗后PaO2/FiO2(391.6±46.7),明显高于治疗前(230.1±35.5),差异均有统计学意义(P均<0.01);血清ALT、AST、BUN、Cr治疗前后的差异均无统计学意义(P均>0.05);痰液病原体的清除率为92.6%;胸部CT检查肺部炎性渗出病灶较前明显吸收;31例存活的重症肺炎患者未观察到不良反应。结论美罗培南对重症肺炎患者有良好的治疗效果。

Objective To evaluate clinical efficacy and safety of meropenem in treating patients with severe pneumonia.Methods Thirty-six patients with severe pneumonia were given meropenem 0.5 or 1 g,q8h intravenously for (10.5±3.5) days.Body temperature change was observed.Serum high-sensitivity C-reactive protein,blood routine test,alanine aminotransferase (ALT),aspartate aminotransferase (AST),blood urea nitrogen (BUN),creatinine (Cr),arterial blood oxygen pressure (PaO2) and oxygenation index (PaO2/FiO2) were compared before and after treatment.Sputum culture and chest CT were reviewed.Adverse reaction of meropenem was evaluated.Results In the 31 surviving patients with severe pneumonia,body temperature decreased significantly to normal within average (3.2±1.3) days.Serum high-sensitivity C-reactive protein level decreased significantly from (70.3±15.2) mg/L to (6.7 ±2.5) mg/L after treatment.Peripheral white blood cell count reduced significantly from (15.8±4.7)×109/L to (7.4±2.1) ×109/L after treatment.PaO2 increased significantly from (46.2±11.9) mmHg to (81.5±15.5) mmHg after treatment.PaO2/FiO2 increased significantly from 230.1±35.5 to 391.6±46.7.All the above comparisons showed statistical significance (P0.05).Sputum pathogen clearance was 92.6%.The pulmonary inflammatory lesions on chest CT subsided apparently after treatment.No adverse reaction was observed in the 31 survivors of severe pneumonia.Conclusions Meropenem shows good therapeutic effect in patients with severe pneumonia.