雾化吸入阿米卡星联合静滴哌拉西林他唑巴坦钠治疗老年重症社区获得性肺炎的临床效果与安全性评价

Clinical effect nebulized inhalation of amikacin combined with intravenous dripping piperacillin and tazobactam sodium in the treatment of elderly severe community-acquired pneumoniaand its safety evaluation

目的探讨评价雾化吸入阿米卡星联合静滴哌拉西林他唑巴坦钠治疗老年重症社区获得性肺炎(severe community-acquired pneumonia,SCAP)的临床效果及安全性。方法选择2019年1月—2020年12月本院收治的86例老年SCAP患者为研究对象,采用随机数表法分为研究组和对照组两组,每组各43例。两组患者均给予静滴哌拉西林他唑巴坦钠治疗,对照组在此基础上联合雾化吸入生理盐水5 ml,研究组在此基础上联合雾化吸入阿米卡星。比较两组患者治疗总有效率、细菌清除率、不良反应发生率、追踪28 d后的病死率,观察分析临床肺部感染评分(Clinical Pulmonary Infection Scores,CPIS)、急性生理与慢性健康状况评分(Acute Physical and Chronic Health EvaluationⅡ,APACHEⅡ)及白细胞(White Blood Cell,WBC)、C-反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT)水平相关评分及机械通气时间、住重症监护室(intensive care unit,ICU)时间、住院时间等治疗情况。结果两组患者治疗后对细菌的清除率比较,差异无统计学意义(P>0.05);研究组患者的治疗总有效率明显高于对照组,差异有统计学意义(P<0.05);两组患者治疗前的CPIS、APACHEⅡ评分及WBC、CRP、PCT水平比较,差异无统计学意义(P>0.05);两组患者治疗10 d后的CPIS、APACHEⅡ评分及WBC、CRP、PCT水平均明显减低,差异具有统计学意义(P<0.05);且研究组患者的CPIS、APACHEⅡ评分及WBC、CRP、PCT水平低于对照组,差异具有统计学意义(P<0.05);研究组患者的平均机械通气时间、平均住ICU时间、平均住院时间均低于对照组,差异具有统计学意义(P<0.05);两组患者不良反应发生率及28 d后病死率比较,差异无统计学意义(P>0.05)。结论雾化吸入阿米卡星联合静滴哌拉西林他唑巴坦钠治疗老年SCAP安全有效,具备推广价值。

Objective To evaluate the clinical effect and safety of nebulized inhalation ofamikacin combined with intravenous dripping piperacillin and tazobactam in the treatment of elderly severe community-acquired pneumonia(SCAP).Methods A total of 86 elderly SCAP patients those were admitted to our department from January 2019 to December 2020 were enrolled as study subjects,and they were randomly divided into a study group(43 cases)and a control group(43 cases)using a random digital table method.Both groups of patients were treated with intravenous infusion of piperacillin and tazobactam sodium.The control group was combined with nebulized inhalation of 5ml of normal saline on this basis,and the study group was combined with nebulized inhalation of amikacin on this basis.To compare the total effective rate,bacterial clearance rate,adverse reaction rate,and fatality rate after 28 days of follow-up between the two groups;observe and analyze clinical-related scores including clinical pulmonary infection scores(CPIS),acute physical and chronic health evaluationⅡ(APACHEⅡ);scores of laboratory test indicators of white blood cell(WBC),C-reactive protein(CRP),procalcitonin(PCT);mechanical ventilation time,and stay in ICU Treatment conditions such as time and hospital stay.Results There was no significant difference in bacteria clearance rate between the two groups after treatment(P>0.05).The total effective rate of treatment in the study group was higher than that of the control group(P<0.05).Before treatment,there were no significant difference in CPIS and APACHEⅡscores and WBC,CRPand PCT levels between the two groups(P>0.05).Ten days after treatment,the CPIS and APACHEⅡscores,WBC,CRP and PCT levels of the two groups were lower than those before treatment(P<0.05),and those of the study group were lower than those in the control group(P<0.05).The average mechanical ventilation time,average stay in ICU,and average hospital stay of the study group were lower than the control group(P<0.05).There were no statistical difference in the 28-day mortality rate and adverse reaction rate between the two groups(P>0.05).Conclusions Atomized inhalation of amikacin combined with intravenous infusion of piperacillin and tazobactam sodium is safe and effective in the treatment of elderly SCAP,and has promotion value.