美罗培南降阶梯治疗对老年呼吸衰竭合并肺部感染的疗效

Effect of meropenem de-escalation therapy on treatment of elderly respiratory failure patients complicated with pulmonary infection

目的研究美罗培南降阶梯治疗对老年呼吸衰竭合并肺部感染的疗效。方法纳入2022年1月-2023年10月在杭州市第一人民医院城北院区进行医治的103例老年呼吸衰竭合并肺部感染患者进行研究,以患者入院先后顺序不同将其分为研究组54例和对照组49例,对照组采用常规抗菌药物治疗,研究组采用美罗培南降阶梯治疗。对两组治疗效果与安全性进行评估,并比较两组患者治疗前后肺功能指标[每分钟静息通气量(VE)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)]、急性生理学与慢性健康状况Ⅱ(APACHEⅡ)评分、肺部感染评分(CPIS)、外周血生物标志物[降钙素原(PCT)、高敏C-反应蛋白(hs-CRP)、正五聚体蛋白(PTX3)、高迁移率族蛋白B1(HMGB1)]水平。结果治疗后研究组疗效率相较于对照组提高(P<0.05);相较于对照组,研究组治疗后VE、FVC、FEV1水平均上升(P<0.05);相较于对照组,研究组治疗后的APACHEⅡ评分及CPIS均下降(P<0.05);相较于对照组,研究组治疗后PCT、hs-CRP、PTX3及HMGB1水平均下降(P<0.05);研究组药物不良反应发生率相较于对照组降低(P<0.05)。结论通过美罗培南降阶梯治疗可有效控制老年呼吸衰竭合并肺部感染患者病情及肺部感染,改善其肺功能,减轻机体炎症反应,并显现出良好的安全性。

OBJECTIVE To observe the effect of meropenem de-escalation therapy on treatment of the elderly respiratory failure patients complicated with pulmonary infection.METHODS A total of 103 elderly respiratory failure patients complicated with pulmonary infection who were treated in Chengei District Hangzhou First People′s Hospital from Jan.2022 to Oct.2023 were enrolled in the study and were divided into the study group with 54 cases and the control group with 49 cases according to the order of admission to the hospital.The control group was given conventional antibiotic therapy,while the study group was treated with meropenem de-escalation therapy.The therapeutic effect and safety of the two groups were evaluated.The lung function indexes[resting ventilation volume per minute(VE),forced vital capacity(FVC),forced expiratory volume in the first second(FEV_(1))],acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,clinical pulmonary infection score(CPIS),peripheral blood biological markers[procalcitonin(PCT),high-sensitivity C-reactive protein(hs-CRP),pentameric protein(PTX3),high mobility group protein B1(HMGB1)]were observed and compared between the two groups of patients before and after the treatment.RESULTS The effective rate of treatment of the study group was significantly higher than that of the control group(P<0.05).The levels of VE,FVC and FEV_(1)of the study group were significantly higher than those of the control group(P<0.05);the APACHEⅡscore and CPIS of the study group were significantly lower than those of the control group(P<0.05);the levels of PCT,hs-CRP,PTX3 and HMGB1 of the study group were significantly lower than those of the control group(P<0.05);the incidence of drug-induced adverse reactions was significantly lower in the study group than in the control group(P<0.05).CONCLUSION The meropenem de-escalation therapy can effectively control the illness condition and pulmonary infection in the elderly respiratory failure patients complicated with pulmonary infection,improve the lung function,alleviate the inflammatory response,and show favorable safety.