不同剂量美罗培南治疗脓毒症休克的临床效果比较

Comparison of clinical effects of different doses of meropenem in the treatment of septic shock

目的 比较不同剂量美罗培南治疗脓毒症休克的临床效果。方法 将106例脓毒症休克患者按随机数字表法分为标准剂量组和高剂量组,每组53例。标准剂量组患者予以标准剂量美罗培南(首次静脉滴注美罗培南1 g,持续30 min以上,然后每8 h静脉滴注美罗培南1 g,每次3 h以上);高剂量组患者予以高剂量美罗培南(首次静脉滴注美罗培南2 g,持续30 min以上,然后每8 h静脉滴注美罗培南2 g,每次3 h以上);其余治疗措施根据患者具体情况而定。主要观察指标为两组患者治疗3、5、7 d时的序贯器官衰竭估计(SOFA)评分和简化的急性生理评分Ⅱ(SAPSⅡ)的增量。次要观察指标为两组患者的院内死亡率,90 d全因病死率,7 d微生物治愈率,7 d临床治愈率,治疗3、5、7 d时的血清降钙素原(PCT)和C反应蛋白(CRP)水平,重症监护室住院天数,呼吸机治疗天数,去甲肾上腺素最高剂量。同时观察两组患者的不良反应发生情况。结果 高剂量组患者治疗7 d时的SOFA评分增量、SAPSⅡ增量,治疗5、7 d时的PCT、CRP水平以及90 d全因病死率均显著低于标准剂量组(P<0.05)。两组间其他指标比较,差异均无统计学意义(P>0.05)。结论 高剂量美罗培南治疗脓毒症休克相比标准剂量美罗培南具有更好的临床效果,且安全性较好。

OBJECTIVE To compare the clinical effects of different doses of meropenem in the treatment of septic shock.METHODS One hundred and six patients with septic shock were randomly divided into standard-dose group and high-dose group,with 53 cases in each group.Patients in the standard-dose group were given standard dose of meropenem(initial intravenous injection of 1 g meropenem more than 30 minutes,followed by 1 g meropenem intravenously every 8 hours,each time for more than 3 hours);patients in the high-dose group were given high dose of meropenem(initial intravenous injection of 2 g meropenem more than 30 minutes,followed by 2 g meropenem intravenously every 8 hours,each time for more than 3 hours);other treatment measures were determined based on the specific conditions of the patients.The main observation indicators were the increments of sequential organ failure assessment(SOFA)scores and simplified acute physiology scoreⅡ(SAPSⅡ)after 3,5 and 7 days of treatment in both groups.Secondary observation indicators included in-hospital mortality,90-day all-cause mortality,7-day microbial cure rate,7-day clinical cure rate,serum procalcitonin(PCT)and C-reactive protein(CRP)levels after 3,5 and 7 days of treatment,hospitalization days in the intensive care unit,ventilator treatment days,the highest dose of norepinephrine.The occurrence of adverse drug reaction in the two groups was observed.RESULTS The increments of SOFA scores and SAPSⅡafter 7 days of treatment,the levels of PCT and CRP after 5 and 7 days of treatment as well as the 90-day all-cause mortality in the highdose group were significantly lower than the standard-dose group(P<0.05).There were no statistically significant differences in other indicators between the two groups(P>0.05).CONCLUSIONS High-dose meropenem treatment for septic shock has better clinical effects and is safer than standard-dose meropenem.