厄他培南在老年急性单纯性阑尾炎非手术治疗中的疗效观察

Clinical observation on the effect of ertapenem in non-operation therapy for uncomplicated acute appendicitis in elderly patients

目的观察厄他培南在老年急性单纯性阑尾炎非手术治疗中的临床疗效。方法 2014年3月至2016年3月于我院急诊诊断为急性单纯性阑尾炎并拒绝急诊手术的患者(≥65岁)。采用随机对照的方法,研究组(35例)应用厄他培南抗炎治疗,对照组(35例)应用头孢+甲硝唑抗炎治疗。观察两组治疗效果。结果老年急性单纯性阑尾炎非手术治疗有效率为62.9%,治愈率为44.3%。厄他培南组治疗有效率为68.6%(治愈率为28.6%),头孢+甲硝唑组有效率为57.1%(治愈率为25.7%),两组对比差异无统计学意义(P>0.05)。厄他培南组及头孢+甲硝唑组48 h症状改善率分别为60.0%及48.6%,近5 d总有效率分别为68.6%、57.1%,两组比较差异无统计学意义(P>0.05)。结论老年急性单纯性阑尾炎非手术疗效一般,在确诊后建议首选手术治疗。针对老年急性单纯性阑尾炎,厄他培南与传统三代头孢+甲硝唑抗炎方案疗效相近,且具有用药方案简易、过敏率低、耐药率低的优点,更适合急诊用药。如急诊老年急性单纯性阑尾炎患者拒绝或不适合手术,可尝试厄他培南抗炎治疗,在治疗期间需密切观察病情变化,48 h未见好转建议急诊手术。

Objective To evaluate the clinical efficacy of ertapenem in the non-operative therapy for elderly patients with uncomplicated acute appendicitis. Methods Seventy elderly patients with uncomplicated acute appendici- tis who refused the appendectomy in emergency department of our hospital from March 2014 to March 2016 were ran- domly divided into two groups. Patients in observation group （ n = 35 ） were treated with ertapenem, while patients in control group （ n = 35 ） were treated with ceftizoxime and metronidazole. The clinical efficacy of the two groups was e- valuated and compared. Results The effective rate of elderly patients with uncomplicated acute appendicitis was 62. 9% with the curative rate was 44. 3%. The total effective rates of observation group and control groups were 68. 6% and 57. 1% ,and the curative rates were 28.6% and 25.7% ,there was no significant difference between the two groups （P 〉0. 05） ; the total effective rates within 5 d were 68.6% and 57. 1% ,and the symptom improvement rates were 48.6% and 40. 0% ,there was no significant difference between the two groups （ P 〉 0.05 ）. Conclusion The clinical efficacy of non-operative treatment for uncomplicated acute appendicitis in elderly patients is lower than ap- pendectomy which is recommended for elderly patients in emergency department. Ertapenem has similar efficacy as ceftizoxime and metronidazole in the treatment of elderly patients with uncomplicated acute appendicitis with the advan- tage of simpler medication region, lower allergy and tolerance rates. If the elderly patient with uncomplicated acute ap- pendicitis is not suitable for surgery, ertapenem therapy could be used. The patients should accept appendicitis if the condition are not improved within 48 h.