改变美罗培南输注方式对恶性血液病伴发热患者临床疗效的研究

Research on the efficacy of meropenem with changed infusion in patients with hematologic malignancies and fever

目的:探讨美罗培南不同输注时间对恶性血液病伴发热患者临床疗效的影响。方法:分析2014年1月–2015年12月血液科病区使用美罗培南两种给药方案治疗的恶性血液病伴发热患者的临床疗效,从临床有效性、细菌学疗效以及炎症指标3个方面进行评价。结果:延长输注组患者体温降为正常的时间平均(3.00±1.12)d,较普通输注组(3.91±1.04)d明显缩短,P<0.05;总有效率为88.23%,较普通输注组(64.41%)显著提高,P<0.05;治疗第5 d C-反应蛋白(CRP)水平下降为(36.25±24.49)mg·L^(-1),较普通输注组(63.80±28.50)mg·L^(-1)明显下降,P<0.05;降钙素原(PCT)水平下降为(0.11±0.06)ng·m L^(-1),较普通输注组(0.30±0.81)ng·m L^(-1)明显下降,P<0.05;痰标本的细菌学清除率中,两组患者对于铜绿假单胞菌的清除率存在显著差异,P<0.05。而美罗培南总治疗时间,其他细菌学清除率两组患者无显著差异,P>0.05。结论:延长美罗培南输注时间对提高恶性血液病伴发热患者临床治疗效果可能具有促进作用。

Objective:To investigate the efficacy of meropenem on different infusion time in the treatment of hematologicmalignancies patients with fever.Methods:The therapeutic effects of two kinds of meropenem regimen in patients with hematologicmalignancies and fever were analyzed from January2014to December2015.Clinical efficacy,effects in bacteriology,and inflammationbiomarkers were evaluated.Results:The time from fever to normothermia was(3.00±1.12)d in the prolonged infusion group,which wassignificantly shorter than normal infusion group(3.91±1.04)d,P<0.05;the total clinical effective rate in the prolonged infusion groupwas88.23%,which was significantly higher than normal infusion group(64.41%),P<0.05;the level of CRP decreased to(36.25±24.49)mg·L-1in the prolonged infusion group on the5th day,which was significantly less than normal infusion group(63.80±28.50)mg·L-1,P<0.05;the level of PCT decreased to(0.11±0.06)ng·mL-1in the prolonged infusion group on the5th day,which was significantlyless than normal infusion group(0.30±0.81)ng·mL-1,P<0.05;removing rates of pseudomonas aeruginosa in the sputum samples weresignificantly different between the two groups,P<0.05.However,the course of treatment time of meropenem therapy and the removingrates on other bacteriology had no significant differences between the two groups,P>0.05.Conclusion:Prolonging the infusion time ofmeropenem could improve the efficacy in patients with hematologic malignancies and fever.