美罗培南治疗晚期非小细胞肺癌合并呼吸机相关性肺炎患者的前瞻性研究

Prospective study of meropenem in treatment of advanced non-small cell lung cancer combined with ventilator-associated pneumonia

目的探讨应用美罗培南治疗晚期非小细胞肺癌（NSCLC）合并呼吸机相关性肺炎（VAP）患者的临床效果,并观察患者预后。方法晚期NSCLC合并VAP患者88例随机分为对照组和治疗组,各44例。对照组进行常规治疗;治疗组在对照组基础上给予美罗培南进行治疗。治疗一个疗程后进行临床效果评估和细菌学评估,检测血液血氧饱和度（Sa O_2）、血氧分压（Pa O_2）水平,比较急性生理学和慢性健康评分（APACHEⅡ）、全身性感染相关组织功能衰竭评分（SOFA）、治疗期间感染控制窗出现时间、症状或体征改善时间。结果治疗组患者总有效率和细菌清除率分别为86.37%和29.55%,明显高于对照组72.73%和13.64%,差异具有统计学意义（χ^2=9.45,U=8.44,P均〈0.05）。两组治疗后Sa O_2、Pa O_2、APACHEⅡ和SOFA评分均高于治疗前,差异具有统计学意义（t分别=10.56、11.40;10.14、12.06;9.26、9.58;8.39、8.87,P均〈0.05）,且治疗组治疗后Sa O_2、Pa O_2、APACHEⅡ和SOFA评分均高于对照组,差异具有统计学意义（t分别=8.35、9.11、7.72、7.29,P均〈0.05）。治疗组患者退热时间、感染控制窗出现时间、肺部啰音消失时间、肺部炎症吸收时间均短于对照组,差异具有统计学意义（t分别=88.44、8.69、9.05、9.13,P均〈0.05）。结论应用美罗培南治疗晚期NSCLC合并VAP患者的具有较好的临床疗效和细菌清除率,能够显著缩短患者好转时间,改善患者预后。

Objective To explore the clinical effect of meropenem on advanced non-small cell lung cancer combined with ventilator-associated pneumonia application meropenem and observe the prognosis. Methods A total of 88 cases of advanced NSCLC combined with VAP were selected and randomly divided into the control group and the treatment group with 44 cases in each. The control group was given conventional treatment, and the treatment group was given meropenem treatment on the basis of the therapy of control group. After one treatment course, the clinical effect and bacteriology were assessed. The monitored blood oxygen saturation（Sa O_2）, blood oxygen pressure（Pa O_2） levels, acute physiology and chronic health evaluation（APACHE Ⅱ） and sepsis-related organ failure assessment（SOFA）were detected. Appeared time of infection control window and improvement time of symptoms were recorded. Results The total efficiency and bacterial clearance rate of the treatment group were 86.37% and 29.55% respectively, which were higher than the control group（72.73% and 13.64%）, the differences were statistically significant（χ~2=9.45,U=8.44,P〈0.05）. After treatment, the Sa O_2,Pa O_2, APACHE Ⅱ and SOFA scores of two groups were significantly higher than before treatment（t =10.56, 11.40,10.14,12.06, 9.26,9.58, 8.39,8.87,P 0.05）. After treatment, the Sa O_2, Pa O_2, APACHE Ⅱ and SOFA scores of the treatment group were significantly higher than the control group（t =8.35, 9.11, 7.72, 7.29,P 0.05）. The temperature lower time, infection control window appeared time, pulmonary rales disappeared time and lung inflammation absorption time of the treatment group were significantly shorter than the control group（t =88.44, 8.69, 9.05,9.13, P 0.05）.Conclusion Meropenem has better clinical efficacy and bacterial eradication rates in treatment of NSCLC with VAP,which can significantly shorten the recovery time and improve the prognosis.