热毒宁注射液联合美罗培南和多黏菌素B治疗MDR-GNB肺部感染的临床疗效和经济学分析

Clinical Efficacy and Economic Analysis of Reduning Injection Combined with Meropenem and Polymyxin B in the Treatment of Pulmonary Infection of MDR-GNB

目的:探讨热毒宁注射液联合美罗培南和多黏菌素B治疗多重耐药革兰阴性菌(MDR-GNB)肺部感染的有效性、安全性和经济性。方法:选取2020年10月至2023年1月该院收治的MDR-GNB肺部感染患者130例,按随机数字表法分为对照组和观察组,每组65例。对照组患者予以多黏菌素B联合美罗培南治疗,观察组患者在对照组的基础上加用热毒宁注射液,疗程均为7~14 d。观察两组患者的临床疗效、细菌清除率、临床感染体征改善时间、治疗前后炎症因子变化和不良反应发生情况;并应用成本-效果分析进行经济学评价。结果:观察组患者的临床总有效率、细菌清除率为87.69%(57/65)、92.31%(60/65),显著高于对照组的72.31%(47/65)、75.38%(49/65),差异均有统计学意义(P<0.05)。观察组患者退热时间、咳嗽咳痰消失时间、肺部啰音消失时间、影像学检查改善时间以及治疗时间显著短于对照组,差异均有统计学意义(P<0.05)。治疗后,观察组患者白细胞计数、C反应蛋白、降钙素原和血清样淀粉蛋白A水平显著低于对照组,差异均有统计学意义(P<0.05)。观察组、对照组患者不良反应发生率分别为10.77%(7/65)、7.69%(5/65),差异无统计学意义(P>0.05)。观察组和对照组临床总有效率的成本-效果比(C/E)分别为352.56和577.88,细菌清除率的C/E分别为334.91和554.34;相对于观察组,对照组临床总有效率、细菌清除率的增量成本-效果比分别为-706.80、-642.09。结论:热毒宁注射液能显著提高多黏菌素B联合美罗培南治疗MDR-GNB肺部感染患者的临床疗效,未显著增加不良反应,且具有显著经济学优势。

OBJECTIVE:To probe into the efficacy,safety and economical efficiency of Reduning injection combined with meropenem and polymyxin B in the treatment of pulmonary infection of multi-drug resistant gram-negative bacteria(MDR-GNB).METHODS:A total of 130 patients with pulmonary infection of MDR-GNB admitted into the hospital from Oct.2020 to Jan.2023 were selected to be divided into the control group and observation group via random number table method,with 65 cases in each group.The control group was given polymyxin B combined with meropenem,while the observation group was given Reduning injection based on the control group,the course of treatment was 7-14 days.The clinical efficacy,bacterial clearance rate,improvement time of clinical signs of infection,changes of inflammatory factors before and after treatment,and incidences of adverse drug reactions of two groups were observed;conomic evaluation was conducted by using cost-effectiveness analysis.RESULTS:The clinical total effective rate and bacterial clearance rate of the observation group were respectively 87.69%(57/65)and 92.31%(60/65),significant higher than those of the control group[72.31%(47/65)and 75.38%(49/65)],with statistically significant differences(P<0.05).The remission time of fever,disappearance time of cough and expectoration,disappearance time of lung rales,improvement time of imageological examination and duration of treatment of the observation group were significantly shorter than those of the control group,with statistically significant differences(P<0.05).After treatment,the white blood cell count,C-reactive protein,procalcitonin and serum amyloid protein A levels of the observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).The incidences of adverse drug reactions of the observation group and the control group were respectively 10.77%(7/65)and 7.69%(5/65),the difference was not statistically significant(P>0.05).The cost-effectiveness(C/E)of clinical effective rates of the observation group and the control group were respectively 352.56 and 577.88,the C/E of bacterial clearance rates were respectively 334.91 and 554.34;relative to the observation group,the incremental cost-effectiveness ratio of clinical effective rate and bacterial clearance rate in the control group were respectively-706.80 and-642.09.CONCLUSIONS:Reduning injection can effectively improve the clinical efficacy of polymyxin B combined with meropenem in the treatment of pulmonary infection of MDR-GNB,without increasing adverse drug reactions,with significant economical efficiency advantages.