美罗培南不同输注模式对儿童严重脓毒症的疗效观察

Clinical efficacy of meropenem by different infusion therapies in treatment of severe sepsis in children

目的探讨美罗培南传统输注模式、延长输注模式和两步输注模式对严重脓毒症患儿临床疗效及细菌清除率的差异。方法选取宁波大学附属妇女儿童医院儿童重症监护中心严重脓毒症患儿60例为研究对象,采用随机数字表法分为A、B、C三组,每组20例。根据推荐的美罗培南治疗剂量,A组:微量泵100ml/h泵入0.5h;B组:微量泵16.7ml/h泵入3h;C组:先以微量泵50ml/h泵入0.5h,然后以微量泵10ml/h泵入2.5h。比较三组治疗前后各观察指标的变化,评估治疗后的临床疗效、细菌清除率和不良反应发生情况。结果两步输注组用药后白细胞计数、C反应蛋白、降钙素原等指标均较传统输注组明显降低。三组的临床疗效比较,B组输注模式治疗总有效率为75%,C组输注模式治疗总有效率为95%,均高于A组的60%,差异有统计学意义(P<0.05)。细菌清除率A组为50%,B组为70%,C组为100%,差异有统计学意义(P<0.05)。不良反应发生率A组为20%、B组为15%,C组为20%,差异无统计学意义(P>0.05)。结论美罗培南两步输注法治疗儿童严重脓毒症,与传统输注法和延长输注法相比,可显著提高临床疗效。

Objective To evaluate the clinical efficacy and clearance rate of pathogens of meropenem by different infusion therapies in treatment of severe sepsis for pediatric patients.Methods Sixty inpatients with serious sepsis from Pediatric Intensive Care Unit,Women and Children’s Hospital of Ningbo University were randomly divided into three groups 20 in each.The meropenem was given according to the recommended therapeutic dose.Group A:The micropump was pumped for 0.5h at a rate of 100ml/h.Group B:The micropump was pumped for 3h at a rate of 16.7ml/h.Group C:Half of the menopenen was pumped for 0.5h at a rate of 50ml/h,and the other half was pumped for 2.5h at a rate of 10ml/h.Changes of indexes were compared before and after the treatment to estimate of the clinical effective rate,clearance rate of pathogens and side effects among the groups.Results There were observable improvements in the inflammatory indicators after treatment,such as white cell count,C-reactive protein and procalcitonin,etc.The total effective rate was 60%in group A,75%in group B,and 95%in group C.There were statistically differences among the groups(P<0.05).Meanwhile,the bacterial clearance rates of the groups were 50%(group A),70%(group B)and 100%(group C),respectively(P<0.05).The rate of side effect was 20%(group A),15%(group B)and 20%(group C),respectively(P>0.05).Conclusion It can significantly improve the clinical efficacy and antibacterial efficacy by the two step infusion therapy of meropenem,compared with traditional infusion therapy and extended infusion.