亚胺培南/西司他丁输注时间对重症肺炎的疗效影响

Effect of different infusion time of imipenem/cilastatin on severe pneumonia

目的观察亚胺培南／西司他丁不同输注时间对重症肺炎疗效的影响。方法117例重度肺炎患者分为三组：对照组38例、实验1组40例、实验2组39例。分别选择予亚胺培南／西司他丁常规0．5h静滴、静脉泵2h输注、静脉泵4h输注．疗程5～14d．比较三组实验室数据变化值及临床疗效。结果实验1组、实验2组与对照组临床疗效有效率比较，差异均具统计学意义（X^2分别=5．67、4．18，P均〈0．05）。而两实验组疗效比较，差异无统计学意义（X^2=O．12，P〉0．05）。三组细菌清除率比较，差异无统计学意义（X^2=0．34，P〉0．05）。三组患者的体温、白细胞计数（WBC）、C反应蛋白（CRP）指标改善情况比较，差异均有统计学意义（F分别=4．04、4.36、8．08，P均〈0．05），而临床肺部感染评分（CPIS）、APACHEⅡ评分改善程度、谷丙转氨酶（Alt）、肌酐（Cr）水平比较，差异无统计学意义（F分别=1．15、0．74、O．70、3．05，P均〉0．05）。进一步两两比较发现，实验1组、实验2组患者体温、WBC、CRP改善程度均较对照组明显（q分别=2．27、2．63：2．13、2．85：3．25、3．69，P均〈0．05）。而实验1组、实验2组的体温、WBC、CRP改善程度比较，差异无统计学意义（q分别=0．39、0．73、0．47，P均〉0．05）。结论亚胺培南／西司他丁输注时间延长后能明显改善重症肺炎患者的治疗效果．但输注时间延长至4h与2h比较，临床疗效无明显改善。

Objective To observe the effect of different infusion time of imipenem/cilastatin on severe pneumonia. Methods A total of 117 patients with severe pneumonia were divided into three groups..38 cases of the control group,40 cases of the experimental group 1,39 eases of the experimental group 2, The imipenem/cilastatin were given respectively conventional intravenous infusion for half an hour, intravenous infusion for 2 hours and intravenous infusion for 4 hours. The courses was 5 - 14 d. The laboratory data and clinical efficacy changes of the three groups were compared. Results Compared with the control group, the differences of clinical efficacy of two experimental groups were statistically significant （X^2=5.67, 4.18, P〈0.05）, and the difference between two experimental groups was not statistically significant （X^2=0.12, P〉0.05）.The difference of bacterial clearance rate among three groups was not statistically significant （x^2=O.34,P〉O.05）. The changes of patient＇s temperature,white blood cell count （WBC）, C-reactive protein （CRP） among three groups were statistically different（F=4.04, 4.36, 8.08,P〈0.05） while the changes of CPIS, APACHE I[ and the level of Alt, Cr among three groups was not statistically different （F=I.15, 0.74, 0.70, 3.05,P〉0.05）. Compared with the control group,the changes of temperature, WBC, CRP of two experimental groups were more sharply（q=2.27,2.63;2.13,2.85;3.25,3.69,P〈 0.05） while there was no significant differences between experimental groups （q=0.39,0.73,0.47,P〉0.05）. Conclusion Extension of imipenem/cilastatin infusion time can significantly improve the clinical effect of patients with severe pneumonia. The clinical effect had no improvement when the infusion time extend 2 hours to 4 hours.