亚胺培南与美罗培南治疗肝硬化自发性细菌性腹膜炎临床对照研究  

A randomized,controlled clinical trial on imipenem versus meropenem for the treatment of spontaneous bacterical peritonitis in liver cirrhosis patients.

作　　者：姬克萍 李珺[1] 韩玉华[1] 苏慧[1] 

机构地区：[1]武警北京总队第二医院消化科,北京100036

出　　处：《中国实用内科杂志》2008年第10期876-878,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的评价两种碳青酶烯类抗生素亚胺培南与美罗培南治疗肝硬化自发性细菌性腹膜炎的疗效和安全性。方法对2006年1月至2008年1月武警北京总队第二医院消化科89例肝硬化自发性细菌性腹膜炎患者,采用单盲随机对照方法分别接受亚胺培南与美罗培南治疗,亚胺培南组45例,美罗培南组44例,观察两组患者临床表现、腹水减退时间、细菌学培养结果及不良反应。临床分离菌株分别进行亚胺培南、美罗培南体外药敏试验。结果经腹水、血、尿培养共获得108株病原菌,治疗后亚胺培南组病原菌清除率为87.9%,美罗培南组为86.0%(P>0.05);两组临床有效率分别为77.8%和70.5%(P>0.05);亚胺培南组体温由(39.2±0.8)℃降至(37.1±0.6)℃,时间为(1.9±0.7)d;美罗培南组由(38.9±0.8)℃降至(37.2±0.7)℃,时间为(3.2±0.9)d;两者差异具有统计学意义(P=0.002),亚胺培南组平均疗程亦较美罗培南组短[(6.6±2.3)d对(7.8±1.8)d,P=0.039],两种药物使用中不良反应发生均较少而轻(11.60%对9.50%,P>0.05)。结论亚胺培南与美罗培南治疗肝硬化自发性腹膜炎安全有效;二者抗菌谱及临床疗效相近,亚胺培南在退热时间及平均疗程上优于美罗培南。Objective To evalulate the efficiency and safety of two kinds of carbapenem antibiotics-imipenem,and mempenem used to treat liver cirrhosis with spontaneous bacterical peritonitis. Methods The clinical behavior,bacteria spectrum and side-effect of forty-five spontaneous bacterical peritonitis case with imipenem, and forty-four with mempenem were randomized ＆ controlled. The isolated bacteria were done ex vivo drug sensitive test with imipenem and meropenem, respectively. Results 108 bectria strains were obtained form the patients ascites, blood and urine in this group, after treatment the bacteria clearance was 87.93% in imipenem and 86. 0% in meropenem （ P 〉 0.05 ）. The total efficiency rate：imipenem was 77. 78% ; meropenem was71.11% （P 〉 0 05 ）. The average time of abatement of fever was （ 1.9 ± 0.7）days [from（39.2 ±0.83）℃ to（37.1 ±0.63）℃]and（3.2 ±0.9）days[from（38.9 ±0.76）℃ to（37.2 ± 0 71 ） ℃ ] respectively（ P = 0. 002 ）. The treatment time in imipenem groups was shorter than of meropenem groups（ 6. 6 ± 2. 3 vs 7. 8 ± 1.8,P =0. 039）. The side reaction was slight in both groups（ 11.60% vs 9. 50% ,P 〉0. 05）. Conclusion Imipenem and meropenem is effective and safe for the treatment of bacterial infection in spontaneous bacterical peritonitis patients. The average time of abatement of fever and treatment time in imipenem groups was shorter than than of meropenem groups.

关 键 词：亚胺培南 美罗培南 肝硬化 自发性腹膜炎 

分 类 号：R5[医药卫生—内科学]