美罗培南降阶梯疗法对老年慢性阻塞性肺疾病合并肺炎患者的效果

Effect of Meropenem de-escalation therapy in the treatment of elderly patients with chronic obstructive pulmonary disease complicated with pneumonia

目的探究美罗培南降阶梯疗法(DET)对老年慢性阻塞性肺疾病(COPD)合并肺炎患者的效果。方法选取联勤保障部队第九〇四医院于2018年6月至2021年6月收治的老年COPD合并肺炎患者,共82例,采用随机数字表法将其分为对照组和观察组,各41例。两组治疗时间均为8 d。对照组给予常规抗生素,观察组采用美罗培南DET。比较两组疗效及呼吸困难、肺部湿啰音、咳嗽的症状消失时间。采集两组治疗后痰液进行细菌培养,计算细菌清除率。检测两组治疗前后炎症水平,观察治疗方案的安全性。结果观察组临床疗效优于对照组,呼吸困难、肺部湿啰音、咳嗽的症状消失时间均短于对照组(P<0.05)。两组细菌清除率及不良反应总发生率比较,差异无统计学意义(P>0.05)。治疗后,两组C反应蛋白、降钙素原水平均低于治疗前,且观察组低于对照组(P<0.05)。结论美罗培南DET能够有效提高老年COPD合并肺炎患者的治疗效果,改善患者血清炎症水平及临床症状,安全可靠。

Objective To explore the effect of Meropenem de-escalation therapy(DET)in the treatment of elderly patients with chronic obstructive pulmonary disease(COPD)complicated with pneumonia.Methods A total of 82 elderly patients with COPD complicated with pneumonia admitted to the 904th Hospital of the Joint Logistics Support Force of Chinese People’s Liberation Army from June 2018 to June 2021 were selected and divided into two groups by random number table method,with 41 cases in each group.The control group was given routine antibiotics,and the observation group was given Meropenem DET.The treatment time of both groups was eight days.The curative effect and the disappearance time of dyspnea,pulmonary moist rales,cough were compared between the two groups.Sputum of the two groups after treatment was collected for bacterial culture,and the bacterial clearance rate was calculated.The level of inflammation before and after treatment in the two groups was detected and the safety of the treatment scheme were observed.Results The clinical efficacy of the observation group was better than that of the control group,and the disappearance time of dyspnea,pulmonary moist rales,cough was shorter than those of the control group(P<0.05).There were no significant differences in bacterial clearance rate and total incidence of adverse reactions between the two groups(P>0.05).After treatment,the levels of C-reactive protein and procalcitonin in two groups were lower than those before treatment,and observation group was lower than control group(P<0.05).Conclusion Meropenem DET can effectively improve the therapeutic effect of elderly patients with COPD complicated with pneumonia,improve the serum inflammation level and clinical symptoms of patients,and is safe and reliable.