【摘要】：目的比較美羅培南常規(guī)輸注(30 min)和延長輸注時(shí)間(3 h)兩種給藥方法治療老年人醫(yī)院獲得性肺炎(HAP)的臨床療效和安全性,觀察腎清除率增加(ARC)對(duì)臨床療效的影響。方法采用開放性隨機(jī)對(duì)照臨床單盲研究。選擇2015年9月-2016年8月住院的需要使用美羅培南治療的老年HAP患者40例。隨機(jī)分為對(duì)照組、研究組各20例。對(duì)照組給藥方案為美羅培南1 g加入0.9%Na Cl溶液100 m L中,使用靜脈輸液泵勻速維持30 min,每8小時(shí)給藥1次;研究組給藥方案為美羅培南1 g加入0.9%Na Cl溶液100 m L中,使用輸液泵勻速維持3 h,每8小時(shí)給藥1次。兩組至少用藥7 d。比較兩組患者的臨床療效和藥物不良反應(yīng)。進(jìn)一步將40例患者中肌酐清除率(Ccr)≥130(m L/min)/1.73 m2的患者列為A1組,其余患者列為A2組。將對(duì)照組和研究組中Ccr≥130(m L/min)/1.73 m2的患者分別列為B1組和B2組。單獨(dú)比較A1組和A2組,B1組和B2組的臨床療效。結(jié)果與對(duì)照組比較,研究組臨床治愈率和28 d生存率明顯升高[臨床治愈率:70.00%(14/20)比50.00%(10/20);28 d生存率:85.00%(17/20)比65.00%(13/20),P均0.05],臨床肺部感染評(píng)分(CPIS)、降鈣素原(PCT)明顯改善[CPIS降低值(分):(2.88±2.51)比(1.25±1.67);PCT降低值(μg/L):(2.43±0.68)比(1.05±0.27),P均0.05],而美羅培南治療天數(shù)、住院時(shí)間無明顯差異(P?0.05)。兩組患者的主要不良反應(yīng)為血清丙氨酸轉(zhuǎn)氨酶升高及腹瀉,不良反應(yīng)發(fā)生率無明顯差異(P0.05)。進(jìn)一步分析,與A2組比較,A1組臨床治愈率,28 d生存率明顯降低[臨床治愈率:44.44%(4/9)比64.52%(20/31);28 d生存率:66.67%(6/9)比77.42%(24/31),P均0.05],CPIS評(píng)分及PCT下降值亦有明顯差異[CPIS降低值(分):1.62±1.61比2.19±2.2;PCT降低值(μg/L):(1.41±0.39)比(1.84±0.5),P均0.05],而美羅培南治療天數(shù)、住院時(shí)間無明顯差異。與B1組比較,B2組的臨床治愈率、28 d生存率明顯提高(臨床治愈率:3/5比1/4;28 d生存率:4/5比2/4,P均0.05),CPIS評(píng)分、PCT值明顯改善[CPIS降低值(分):(2.56±2.29)比(0.68±0.93);PCT降低值(μg/L):(2.21±0.63)比(0.61±0.15),P均0.05],美羅培南治療天數(shù)、住院時(shí)間無明顯差異(P0.05)。結(jié)論與30 min常規(guī)輸注給藥方法相比,延長美羅培南輸注時(shí)間至3 h可以提高老年HAP患者的臨床療效,不良反應(yīng)未增加。ARC導(dǎo)致患者臨床療效下降,通過延長美羅培南輸注時(shí)間可提高ARC患者的臨床療效。
[Abstract]:Objective to compare the clinical efficacy and safety of routine meropenem infusion (30 min) and prolonged infusion time (3 h) in the treatment of (HAP) in elderly patients with nosocomial pneumonia. To observe the effect of increasing renal clearance rate (ARC) on clinical efficacy. Methods an open randomized controlled clinical single blind study was used. Forty elderly HAP patients who were hospitalized with meropenem from September 2015 to August 2016 were selected. The patients were randomly divided into control group (n = 20). In the control group, 1 g of meropenem was added to 100ml of 0.9%Na Cl solution, and the intravenous infusion pump was used to maintain the drug at a constant rate of 30 min, every 8 hours. In the study group, meropenem 1 g was added to 100ml 0.9%Na Cl solution, and the infusion pump was used for 3 h, once every 8 hours. The two groups were treated for at least 7 days. The clinical efficacy and adverse drug reactions were compared between the two groups. 40 patients with creatinine clearance (Ccr) 鈮，

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