亚胺培南西司他丁治疗老年肺部感染的药代动力学研究及临床疗效评价

Pharmacokinetic study of imipenem and cilastatin in the treatment of elderly pulmonary infection and assessment of its clinical efficacy

目的探讨亚胺培南西司他丁治疗老年肺部感染的药代动力学并评价其临床疗效。方法将90例老年肺部感染患者随机分成观察组和对照组,分别采用亚胺培南西司他丁钠治疗和头孢哌酮钠舒巴坦钠治疗,并检测观察组5例患者的血药浓度动态变化及6例气管肺泡灌洗液中的药物浓度,比较两种方法的细菌学疗效及临床疗效。结果 1观察组5例肝肾功能正常的肺部感染患者亚胺培南西司他丁钠药动学变化显示,峰值浓度为(28.46±0.79)mg/L,半衰期约1 h、8 h后血药浓度为(2.21±0.76)mg/L;2观察组6例患者静滴亚胺培南西司他丁钠静滴1.5 h后肺泡灌洗液中亚胺培南西司他丁钠的平均浓度为(1.312±0.169)mg/L,蛋白量为(0.202±0.016)g/L,药物浓度/蛋白量为(6.645±1.189)mg/g;3观察组细菌清除率为94.1%,对照组细菌清除率达77.1%,观察组细菌清除率大于对照组(P<0.05);4治疗1个疗程后,观察组总有效率为93.3%,对照组总有效率为86.7%,观察组总有效率高于对照组,但差异无统计学意义(P>0.05);5两组不良反应均较少。结论亚胺培南西司他丁半衰期较短,肺部组织中药物浓度高,临床疗效显著。

Objective To discuss the pharmacokinetics of imipenem and cilastatin in the treatment of elderly pulmonary infection and to assess its clinical efficacy. Methods Ninety elderly patients with pulmonary infection were randomly assigned to the observation group and the control group. They were given the treatment of imipenem and cilastatin, and the treatment of cefoperazone sodium and sulbactam sodium respectively. Dynamic changes of plasma concentration of 5 patients in the observation group, as well as the drug concentration in bronchoalveolar lavage fluid in 6 patients were tested. Bacteriological effect and clinical efficacy of the two methods were compared. Results 1 In 5 patients with pulmonary infection and normal renal and hepatic function in the observation group, pharmacokinetic changes of imipenem and cilastatin showed that： peak concentration was（28.46±0.79） mg/L, and half life was about 1 h.The plasma concentration after 8h was（2.21±0.76） mg/L. 2 In the 6 patients in the observation group, after 1.5 h of intravenous injection of imipenem and cilastatin, the mean concentration of imipenem and cilastatin in bronchoalveolar lavage fluid was（1.312±0.169） mg/L, the content of protein was（0.202±0.016） g/L, and the drug concentration/content of protein was（6.645±1.189） mg/g. 3The clearance rate of bacteria was 94.1% in the observation group; the clearance rate of bacteria in the control group was 77.1%. The clearance rate in the observation group was higher than that in the control group（P〈0.05）. 4 After one course of treatment, the total effective rate in the observation group was 93.3%, and the total effective rate in the control group was 86.7%. The total effective rate in the observation group was higher than that in the control group, but the difference was not statistically significant（P〉0.05）. 5 The adverse effects were relatively few in both groups. Conclusion The half life of imipenem and cilastatin is shorter, the drug concentration in pulmonary tissues is higher, and the clinical efficacy is significant.