头孢吡肟的不同输注时间对化疗后粒细胞缺乏性发热患者临床疗效及结局的影响

Effect of different infusion time of cefepime on clinical efficacy and outcome of patients with febrile neutropenia after chemotherapy

目的:优化头孢吡肟的使用方法,探讨不同输注时间对头孢吡肟临床疗效及结局的影响。方法:将符合入组标准的化疗后中性粒细胞缺乏性发热(febrile neutropenia,FN)的患者,随机分为标准组和延长组,标准组:0.9%氯化钠溶液(NS)100 mL+头孢吡肟2 g,静脉滴注30 min,q8h;延长组:NS 100 mL+头孢吡肟2 g,静脉滴注3 h以上,q8h。观察2组患者24,48,72 h退热率,临床治疗成功率,住院时间,C反应蛋白(C-reactive protein,CRP)72 h变化值。结果:实际完成治疗患者共106例,其中标准组52例、延长组54例。标准组、延长组24 h退热率分别为27%、52%,差异有统计学意义(P=0.009);48 h退热率分别为56%、65%,72 h退热率分别为71%、81%,差异均无统计学意义,但延长组均有提高的趋势。2组患者中位退热时间分别为44,23 h,差异有统计学意义(χ^(2)=5.396,P=0.020)。2组患者临床治疗成功率分别为69%、83%,住院天数分别为16.5,13 d,差异均无统计学意义;72 h的CRP变化值分别为(58.36±38.20)、(77.84±47.36)mg·L^(-1),差异有统计学意义(P=0.022)。结论:延长头孢吡肟的单次输注时间,可能有助于提高FN患者的临床疗效,值得进一步研究。

OBJECTIVE To explore the effect of different infusion time of cefepime on clinical efficacy and outcome,and optimize the use of cefepime.METHODS Febrile neutropenia(FN)patients who met the inclusion criteria were randomly divided into standard group and extended group.Standard group:0.9%Soium Chloride Solution(NS)100 mL+cefepime 2 g,by intravenous infusion for 30 minutes,q8h;extended group:NS 100 mL+cefepime 2 g,by intravenous infusion for more than 3 h,q8h.The antipyretic rates at 24,48 and 72 h,clinical treatment success rate,length of stay and 72-h change value of C-reactive protein(CRP)were observed in the two groups.RESULTS A total of 106 patients actually completed the treatment,including 52 patients in the standard group and 54 patients in the extended group.The 24-h antipyretic rates of standard group and extended group were 27%and 52%,respectively,and the difference was statistically significant(P=0.009).The antipyretic rates of the two groups were 56%and 65%at 48 h,and 71%and 81%at 72 h,respectively,with no significant statistical difference.However,there was a trend of higher antipyretic rate in the extended group.The median antipyretic time of the two groups was 44 and 23 h,respectively,and the difference was statistically significant(χ^(2)=5.396,P=0.020).The clinical success rates and hospitalization days of the two groups were 69%and 83%,16.5 and 13 days,respectively,and there was no significant statistical difference.The 72-h change value of CRP of the two groups were(58.36±38.20)and(77.84±47.36)mg·L^(-1),respectively,and the difference was statistically significant(P=0.022).CONCLUSION Prolonged infusion time of cefepime may improve the clinical outcome of FN patients,which is worthy of clinical trials and further research.