两种不同方法输注美罗培南治疗重症感染患者的效果比较

Effects of 2 different infusion methods of meropenem on severe infection patients

目的比较两种不同方法输注美罗培南治疗重症感染患者的效果。方法选取2015年1月1日至2016年12月31日入住四川省肿瘤医院重症监护病房(ICU)接受美罗培南治疗的重症感染患者53例为研究对象。采用随机数字表法将患者分为观察组(28例)和对照组(25例)。观察组采用优化两步输注法治疗,对照组采用常规间歇输注法治疗。观察2组患者的临床疗效[包括美罗培南治疗疗程、气管插管患者呼吸机通气时间、ICU治疗天数、总住院天数及医院内死亡率,治疗72 h后血清降钙素原、外周血白细胞计数(WBC)、C反应蛋白(CRP)水平]。结果 2组治疗疗程差异无统计学意义(P>0.05)。观察组中气管插管患者呼吸机通气时间、ICU治疗天数及总住院天数均短于对照组[(5±3)d比(9±5)d、(6±4)d比(10±6)d、(22±14)d比(31±15)d],差异均有统计学意义(均P<0.05)。观察组医院内死亡率低于对照组[14.3%(4/28)比32.0%(8/25)],但差异无统计学意义(P>0.05)。2组治疗72 h后降钙素原、WBC及CRP均低于治疗前,且观察组降钙素原及WBC低于对照组(均P<0.05)。结论优化两步输注法与传统的间歇输注法相比,能明显缩短气管插管患者呼吸机通气时间、ICU治疗天数及总住院天数,同时在改善治疗72 h后的降钙素原及WBC 2个感染指标方面更具优势。

Objective To compare the effects of 2 different infusion methods of meropenem 9n severe infection patients. Methods Fifty-three patients with severe infection who were treated by meropenem in Intensive Care Unit, Sichuan Cancer Hospital from January 1, 2015 to December 31, 2016 were randomly divided into observation group（ 28 cases） and control group （25 cases）. The observation group was treated by modified two-step infusion of meropenem; the control group was treated by routine intermittent infusion of meropenem. Therapeutic course of meropenem, mechanical ventilation time, ICU stay time, total hospital stay time and in-hospital mortality rate were recorded. Levels of serum procalcitonin （PCT）, peripheral blood white blood cell count （WBC） and C-reactive protein（CRP） were tested before and 72 h after treatment. Results Therapeutic course showed no significant difference between groups （ P 〉 0.05 ）. Mechanical ventilation time, ICU stay time and total hospital stay time in observation group were significantly shorter than those in control group [ （5 ± 3 ）d vs （9±5 ）d, （6± 4 ） d vs （ 10 ± 6 ） d, （ 22± 14 ） d vs （ 31 ± 15 ） d ] （ P 〈 0.05 ）. In-hospital mortality rate in observation group was lower than that in control group[ 14. 3% （4/28） vs 32. 0% （ 8/25 ） ] （ P 〉 0.05 ）. After 72 h treatment, PCT, WBC and CRP were significantly lower than those before treatment in both groups; PCT, WBC and CRP in observation group were significantly lower than those control group （ P 〈 0. 05 ）. Conclusion Proper use of meropenem can significantly shorten mechanical ventilation time, ICU stay time, total hospital stay time and reduce infection.