阿米卡星治疗老年重症肺炎的可行性及改善患者肺功能的研究

Study on the feasibility of amikacin in the treatment of senile severe pneumonia and the clinical effect of improving lung function

目的 研究阿米卡星治疗老年重症肺炎的可行性及改善患者肺功能的临床疗效。方法 将215例老年重症肺炎患者采用随机数字表法分为对照组(107例)和观察组(108例)。对照组采用美罗培南进行治疗,观察组在对照组的基础上采用阿米卡星进行治疗,2组均治疗2周。统计2组治疗2周后的临床疗效及治疗期间不良反应的发生情况,比较2组临床症状改善时间、细菌清除率及治疗前和治疗2周后的肺功能、血清细胞因子水平。结果 治疗2周后,观察组总有效率(91.67%)高于对照组(81.31%),细菌清除率(73.15%)高于对照组(54.21%),平均痰液颜色改变时间、平均发热时间、平均肺部炎症吸收时间和平均机械通气时间均短于对照组(P<0.05)。治疗后,2组功能残气量(functional residual capacity,FRC)及血清表面活性蛋白-D(surfactant protein-D,SP-D)、C反应蛋白(C-reactive protein,CRP)和降钙素原(procalcitonin,PCT)水平均降低,且观察组低于对照组,2组第1秒用力呼气容积(forced expiratory volume in one second,FEV1)、用力肺活量(forced vital capacity,FVC)和深吸气量(inspiratory capacity,IC)升高,观察组高于对照组(P<0.05)。治疗期间,总不良反应发生率观察组(20.37%)与对照组(15.89%)的差异无统计学意义。结论 阿米卡星治疗老年重症肺炎,可有效改善患者临床症状及血清细胞因子水平,提高细菌清除率,缓解患者肺功能损伤,具有较好的临床疗效,可行性较好。

Objective To study the feasibility of amikacin in the treatment of senile severe pneumonia and the clinical effect of improving lung function.Methods A total of 215 elderly patients with severe pneumonia were divided into a control group(107 cases)and an observation group(108 cases)by random number table method.The control group was treated with meropenem,and the observation group was treated with amikacin on the basis of the control group.The both groups were treated for 2 weeks.The clinical curative effect after 2 weeks of treatment and adverse reactions during the treatment period of the 2 groups were counted.The improvement time of clinical symptoms,the bacterial clearance rate,the lung function and the level of serum cytokine before and after 2 weeks of treatment were compared.Results After 2 weeks of treatment,the total effective rate of the observation group(91.67%)was higher than that of the control group(81.31%),the bacterial clearance rate of the observation group(73.15%)was higher than that of the control group(54.21%),and the average sputum color change time,the average fever time,the average lung inflammation absorption time and the average mechanical ventilation time were shorter than those of the control group(P<0.05).After treatment,compared with before treatment,the functional residual capacity(FRC),the levels of serum surfactant protein-D(SP-D)and C-reactive protein(CRP)and procalcitonin(PCT)in the 2 groups both decreased,and those in the observation group were lower than those in the control group.The forced expiratory volume in one second(FEV1),the forced vital capacity(FVC),and the inspiratory capacity(IC)in the 2 groups increased,and those in the observation group were higher than those in the control group(P<0.05).During the treatment period,the total incidence of adverse reactions in the observation group was 20.37%,and that in the control group was 15.89%,there was no significant difference between the 2 groups(P>0.05).Conclusion Amikacin could effectively improve the clinical symptoms and the level of serum cytokine,increase the bacterial clearance rate,and relieve the lung function damage in elderly patients with severe pneumonias.It had a good clinical effect and was feasible.