优化美罗培南治疗老年脓毒血症的临床分析

目的 分析血药浓度监测(TDM)优化美罗培南治疗老年脓毒血症的临床疗效。方法 选择2021年1月至2022年2月我院收治的脓毒血症老年患者64例，随机分为对照组31例，观察组33例。对照组接受常规美罗培南治疗，观察组接受TDM优化美罗培南，对比治疗1周后两组病情变化、生化指标、肺功能、实验室指标与不良反应等。结果 治疗1周后，观察组APACHEⅡ评分/SOFA评分低于对照组(P<0.05),观察组肌酐、胆红素、AST、ALT、EVLW、PVPI下降(P<0.05),观察组白细胞、降钙素原、C-反应蛋白水平低于对照组(P<0.05),观察组美罗培南药物谷浓度与峰浓度高于对照组(P<0.05),观察组PK/PD参数最低抑菌浓度(MIC)为1、2、4时血清药物浓度高于MIC的时间(%T>MIC)优于对照组(P<0.05)。结论 65岁以上老年脓毒血症患者，实施TDM优化美罗培南治疗，可降低病情严重水平，调控机体生化指标、炎症指标，提高药物抗菌活性、药物有效浓度，改善患者肺功能，减少药物不良反应，具有临床意义。

Analysis of blood concentration monitoring to optimize the effect of meropenem in the treatment of sepsis in the elderly

ObjectiveTo analyze the clinical efficacy of serum concentration monitoring (TDM) to optimize meropenem in the treatment of senile sepsis. MethodsALL of 64 elderly patients with sepsis treated in our hospital from January 2021 to February 2022 were included for observation. They were randomly divided into two groups: 31 patients in the control group received conventional meropenem treatment, and 33 patients in the study group received TDM optimized meropenem; The changes of disease conditions, biochemical indicators, laboratory indicators and adverse reactions of the two groups after one week of treatment were compared. ResultsAfter one week of treatment, APACHE Ⅱ score/SOFA score in the study group was lower than that in the control group, with statistical significance (P<0.05). Compared with the treatment for 1 day, creatinine, bilirubin, AST, ALT, EVLW, PVPI and other indicators in the study group decreased after 1 week of treatment, with a statistically significant difference (P<0.05). The levels of white blood cells, procalcitonin and C-reactive protein in the study group were lower than those in the control group after 1 week of treatment, with statistical significance (P<0.05). The trough concentration and peak concentration of patients in the study group were higher than those in the control group, with statistical significance (P<0.05); When the PK/PD parameter MIC of the study group was 1, 2, and 4, the patient′s% T>MIC was significantly better than that of the control group, with statistical significance (P<0.05). ConclusionsFor the elderly patients with sepsis over 65 years old, the TDM optimized meropenem treatment can better help patients reduce the severity of the disease, regulate the body′s biochemical indicators and inflammatory indicators, improve the antibacterial activity and effective concentration of drugs, improve the renal function of patients, reduce adverse drug reactions, and is worth promoting.