美罗培南持续泵入联合乌司他丁治疗重症肺炎的临床研究

Clinical study on meropenem continuous pump infusion combined with ulinastatin in treatment of severe pneumonia

目的探讨注射用美罗培南持续泵入联合注射用乌司他丁治疗重症肺炎的临床疗效。方法选取2015年6月—2018年6月天津市宁河区医院收治的104例重症肺炎患者作为研究对象,采用随机数字表法将所有患者分为静脉滴注美罗培南组(33例)、持续泵入美罗培南组(35例)、联合组(36例)。静脉滴注美罗培南组采用静脉滴注注射用美罗培南,将1 g与0.9%氯化钠注射液250mL混合,1次/8h;持续泵入美罗培南组持续泵入注射用美罗培南,将3g与0.9%氯化钠注射液50mL混合,1次/d;联合组在持续泵入美罗培南组的基础上静脉注射注射用乌司他丁,将25万U加入0.9%氯化钠注射液100 mL混合,2次/d。3组患者均治疗7 d。观察患者的临床疗效,同时比较3组的临床症状消失时间、急性生理与慢性健康状况评估Ⅱ评分(APACHEⅡ)、动脉血气指标和血清炎症因子水平。结果治疗后,静脉滴注美罗培南组、持续泵入美罗培南组和联合组的总有效率分别为60.61%、74.29%、91.67%,组间比较差异具有统计学意义(P<0.05)。治疗后,持续泵入美罗培南组、联合组的退热时间、肺部啰音消失时间、咳嗽消失时间均明显短于静脉滴注美罗培南组,且联合组明显低于持续泵入美罗培南组,组间比较差异具有统计学意义(P<0.05)。治疗后,3组氧分压(pO_2)和氧合指数(OI)水平均显著升高,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,联合组pO_2水平显著高于静脉滴注美罗培南组和持续泵入美罗培南组,组间比较差异具有统计学意义(P<0.05);治疗后,持续泵入美罗培南组、联合组OI水平均显著高于静脉滴注美罗培南组,且联合组高于持续泵入美罗培南组,组间比较差异具有统计学意义(P<0.05)。治疗后,3组患者血清中白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)水平均显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,持续泵入美罗培南组、联合组血清炎症因子水平均显著低于静脉滴注美罗培南组,且联合组低于持续泵入美罗培南组,组间比较差异具有统计学意义(P<0.05)。治疗后,3组APACHEⅡ评分均低于治疗前,同组治疗前后比较差异具有统计学意义(P<0.05);治疗后,持续泵入美罗培南组、联合组的APACHEⅡ评分均显著低于静脉滴注美罗培南组,且联合组明显低于持续泵入美罗培南组,组间比较差异具有统计学意义(P<0.05)。结论注射用美罗培南持续泵入联合注射用乌司他丁治疗重症肺炎具有较好的临床疗效,可有效改善患者病情,降低机体炎症反应,改善患者动脉血气指标,无严重并发症,具有一定的临床推广应用价值。

Objective To investigate the clinical efficacy of Meropenem for injection continuous pump infusion combined with Ulinastatin for injection in treatment of severe pneumonia.Methods Patients (104 cases) with severe pneumonia in Ninghe District Hospital of Tianjin from June 2015 to June 2018 were randomly divided into meropenem intravenous drip group (33 cases),meropenem continuous pump infusion group (35 cases),and combined treatment group (36 cases).Patients in the meropenem intravenous drip group were iv administered with Meropenem for injection,1 g mixed with 0.9% Sodium Chloride Injection 250 mL,once every 8 h.Patients in the meropenem continuous pump infusion group were continuously pumped with Meropenem for injection,3 g added to 0.9% Sodium Chloride Injection 50 mL,once daily.The combined treatment group were iv administered with Ulinastatin forinjection on the basis of meropenem continuous pump infusion group,250 000 U added to 0.9% Sodium Chloride Injection 100 mL,twice daily.Patients in three groups were treated for 7 d.After treatment,the clinical efficacy was evaluated,and the clinical symptom disappearance time,APACHE Ⅱ scores,arterial blood gas indexes,and serum inflammatory factor levels in three groups were compared.Results After treatment,the clinical efficacies in the meropenem intravenous drip group,meropenem continuous pump infusion group,and combined treatment group were 60.61%,74.29%,and 91.67%,respectively,and there was difference among three groups (P < 0.05).After treatment,the antipyretic time,lung rale disappearance time,and cough disappearance time in the meropenem continuous pump infusion group and combined treatment group were significantly shorter than those in the meropenem intravenous drip group,and the clinical symptom disappearance time in the combined treatment group were significantly shorter than those in the meropenem continuous pump infusion group,with significant difference among three groups (P < 0.05).After treatment,pO2 and OI levels in the three groups were increased,and the difference was statistically significant in the same group (P < 0.05).After treatment,pO2 in the combined treatment group were significantly higher than those in the meropenem intravenous drip group and meropenem continuous pump infusion group,and there were differences amoing three groups (P < 0.05).After treatment,OI in the meropenem continuous pump infusion group and combined treatment group were significantly higher than those in the meropenem intravenous drip group,and the arterial blood gas indexes in the combined treatment group were significantly higher than those in the meropenem continuous pump infusion group,and there were differences among three groups (P < 0.05).After treatment,the serum IL-1β,TNF-α,PCT,and CRP levels in the three groups were decreased,and the difference was statistically significant in the same group (P < 0.05).After treatment,serum inflammatory factor levels in the meropenem continuous pump infusion group and combined treatment group were significantly lower than those in the meropenem intravenous drip group,and the combined treatment group were significantly lower than those in the meropenem continuous pump infusion group,and there were differences among three groups (P < 0.05).After treatment,APACHE Ⅱ scores in the three groups were significantly decreased,and the difference was statistically significant in the same group (P < 0.05).After treatment,APACHE Ⅱ scores in the meropenem continuous pump infusion group and combined treatment group were significantly lower than those in the meropenem intravenous drip group,and the scores in the combined treatment group were significantly lower than meropenem continuous pump infusion group (P < 0.05).Conclusion Meropenem for injection continuous pump infusion combined with Ulinastatin for injection has good clinical efficacy in treatment of severe pneumonia,can effectively improve the patient's condition,reduce the inflammation,and improve the arterial blood gas indexes,without serious complications,which has a certain clinical application value.