美罗培南延长输注时间治疗老年人医院获得性肺炎的临床研究  

Clinical evaluation of prolonged infusion versus standard infusion of meropenem in the treatment of hospital-acquired pneumonia in elderly patients

作　　者：张勇[1] 丁荣[1] 张景 ZHANG Yong;DING Rong;ZHANG Jing.(Department of Respiratory Medicine, Taizhou No. 4 People＇s Hospital, Taizhou Jiangsu 225300, Chin)

机构地区：[1]江苏省泰州市第四人民医院呼吸内科,江苏泰州225300

出　　处：《中国感染与化疗杂志》2017年第6期623-628,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的比较美罗培南常规输注(30 min)和延长输注时间(3 h)两种给药方法治疗老年人医院获得性肺炎(HAP)的临床疗效和安全性,观察肾清除率增加(ARC)对临床疗效的影响。方法采用开放性随机对照临床单盲研究。选择2015年9月-2016年8月住院的需要使用美罗培南治疗的老年HAP患者40例。随机分为对照组、研究组各20例。对照组给药方案为美罗培南1 g加入0.9%Na Cl溶液100 m L中,使用静脉输液泵匀速维持30 min,每8小时给药1次;研究组给药方案为美罗培南1 g加入0.9%Na Cl溶液100 m L中,使用输液泵匀速维持3 h,每8小时给药1次。两组至少用药7 d。比较两组患者的临床疗效和药物不良反应。进一步将40例患者中肌酐清除率(Ccr)≥130(m L/min)/1.73 m2的患者列为A1组,其余患者列为A2组。将对照组和研究组中Ccr≥130(m L/min)/1.73 m2的患者分别列为B1组和B2组。单独比较A1组和A2组,B1组和B2组的临床疗效。结果与对照组比较,研究组临床治愈率和28 d生存率明显升高[临床治愈率: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],临床肺部感染评分(CPIS)、降钙素原(PCT)明显改善[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],而美罗培南治疗天数、住院时间无明显差异(P>?0.05)。两组患者的主要不良反应为血清丙氨酸转氨酶升高及腹泻,不良反应发生率无明显差异(P>0.05)。进一步分析,与A2组比较,A1组临床治愈率,28 d生存率明显降低[临床治愈率: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评分及PCT下降值亦有明显差异[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],而美罗培南治疗天数、住院时间无明显差异。与B1组比较,B2组的临床治愈率、28 d生存率明显提高(临床治愈率:3/5比1/4;28 d生存率:4/5比2/4,P均<0Objective To compare the clinical efficacy and safety of meropenem administered by standard 30-minute infusion or prolonged 3-hour infusion regimen in treatment of hospital acquired pneumonia(HAP) in elderly patients, and evaluate the effect of augmented renal clearance on clinical efficacy. Methods An open-label randomized controlled clinical trial was conducted. A total of 40 elderly patients(≥65 years of age) with HAP requiring meropenem therapy were enrolled from September 1, 2015 to August 31, 2016. The patients were randomly assigned to receive meropenem 1.0 g in 100 m L of 0.9% Na Cl solution by constant-rate continuous intravenous infusion over 3 hours(study group, n=20) or by constant-rate intravenous infusion over 30 minutes(control group, n=20), every 8 hours, for at least 7 days. Clinical efficacy and safety were compared between groups. According to the level of creatinine clearance(Ccr), the 40 patients were further divided into group A1 [Ccr≥130(m L/min)/1.73 m2] and A2 [Ccr<130(m L/min)/1.73 m2]. The patients with Ccr≥130(m L/min)/1.73 m2 in control group belonged to group B1, and those in study group belonged to group B2. Clinical efficacy was compared between group A1 and A2, and between group B1 and B2. Results The clinical cure rate was 70.00%(14/20) in study group and 50.00%(10/20) in control group(P<0.05). The 28-day survival rate was 85.00%(17/20) in study group and 65.00%(13/20) in control group(P<0.05). The clinical pulmonary infection score(CPIS) was improved significantly in study group(reduction of 2.88±2.51) than in control group(reduction of 1.25±1.67)(P<0.05). Procalcitonin(PCT) level was more improved in study group [reduction of(2.43±0.68) μg/L] than in control group [reduction of(1.05±0.27) μg/L](P<0.05). The duration of meropenem treatment and days of hospital stay did not show significant difference between study group and control group(P>0.05). The common adverse reactions were transient elevation of serum transaminases and diarrhea in both groups. The incidence of

关 键 词：美罗培南 延长输注时间给药 医院获得性肺炎 肾清除率增加 

分 类 号：R563.1[医药卫生—呼吸系统]