美罗培南、头孢曲松分别联合甲硝唑在经皮肝穿刺治疗细菌性肝脓肿中的应用效果比较

Comparison of the Application Effect of Meropenem and Ceftriaxone Combined with Metronidazole in the Treatment of Pyogenic Liver Abscess by Percutaneous Liver Puncture

目的:研究美罗培南联合甲硝唑、头孢曲松联合甲硝唑在经皮肝穿刺治疗细菌性肝脓肿(PLA)中的效果与安全性。方法:选取锦州医科大学附属第一医院2020年1-8月收治的PLA患者82例作为研究对象,采用随机数字表法分为两组,两组均于超声引导下行经皮穿刺置管引流术,术后予0.9%氯化钠注射液冲洗,在病原菌培养和药敏分析结果出来前,对照组(41例)给予头孢曲松联合甲硝唑治疗,观察组(41例)给予美罗培南联合甲硝唑治疗。治疗前、治疗5 d后抽取患者空腹静脉血检测白介素-8(IL-8)、超敏C反应蛋白(hs-CRP)水平,并评价疗效和不良反应。结果:治疗5 d后,两组IL-8、hs-CRP水平均较治疗前明显降低,差异有统计学意义(P<0.05);观察组IL-8、hs-CRP水平均低于对照组,差异有统计学意义(P<0.05)。观察组体温恢复正常时间早于对照组,置引流管时间和住院时间均短于对照组,差异有统计学意义(P<0.05)。两组肝脓腔消失时间比较,差异无统计学意义(P>0.05)。两组均无药物相关不良反应,两组并发症发生率比较,差异无统计学意义(P>0.05)。结论:与头孢曲松联合甲硝唑相比,美罗培南联合甲硝唑经皮肝穿刺治疗可更进一步降低PLA患者的炎性反应,缩短置管时间和住院时间,提高疗效,且不增加不良反应,建议推广应用。

Objective:To study the efficacy and safety of Meropenem combined with Metronidazole,Ceftriaxone combined with Metronidazole in the treatment of pyogenic liver abscess(PLA)by percutaneous liver puncture.Method:A total of 82 patients with PLA who were admitted to the First Affiliated Hospital of Jinzhou Medical University from January to August 2020 were selected as the research objects,and they were divided into two groups by random number table method.Both groups were treated with percutaneous puncture drainage under the guidance of ultrasound.After the operation,they were given 0.9%sodium chloride injection for washing.Before the results of pathogen culture and drug sensitivity analysis were obtained,the control group(41 cases)was given Ceftriaxone combined with Metronidazole,and the observation group(41 cases)was given Meropenem combined with Metronidazole.Before treatment and 5 days after treatment,fasting venous blood was drawn from patients to detect the levels of interleukin-8(IL-8)and high-sensitivity C-reactive protein(hs-CRP),and to evaluate the efficacy and adverse reactions.Result:After 5 days of treatment,the levels of IL-8 and hs-CRP in the two groups were significantly lower than those before treatment,and the differences were statistically significant(P<0.05),the levels of IL-8 and hs-CRP in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).The time of body temperature returning to normal in the observation group was earlier than that in the control group,and the time of placing the drainage tube and the hospitalization time were shorter than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the disappearance time of liver abscess between the two groups(P>0.05).There were no drug-related adverse reactions in the two groups,and there was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Compared with Ceftriaxone combined with Metronidazole,Meropenem combined with Metronidazole percutaneous liver puncture can further reduce the inflammatory response in patients with PLA,shorten the time of intubation and hospitalization,and improve the curative effect without increasing adverse effects response,it is recommended to promote the application.