美罗培南输注时间和剂量对铜绿假单胞菌感染患者疗效的影响

目的探讨美罗培南输注时间对中重症铜绿假单胞菌患者的疗效影响及其安全性。方法方便性抽样选取2009年6月至2010年9月在东阳市人民医院住院、年龄18～60岁的中重度铜绿假单胞菌感染、临床判断需要给予美罗培南连续治疗的51例患者,获得知情同意书后随机分为三组:大剂量30min输注治疗组(A组)、大剂量3h输注治疗组(B组)和小剂量3h输注治疗组(C组),每组各17例患者,观察三组患者的临床疗效及治疗期间的不良反应。首要疗效标准为给药72h后体温及白细胞计数的变化,次要疗效标准包括抗生素临床疗效及细菌学疗效,安全性评估包括不良事件观察及不良反应发生率。结果给药72h后,白细胞计数各组间比较差异无统计学意义(均P>0.05);体温下降幅度B组高于A组和C组(P<0.05),A组和C组间比较差异无统计学意义(P>0.05)。停药当天,B组临床有效率及细菌清除率高于A组和C组(P<0.05),A组和C组间比较差异无统计学意义(P>0.05)。结论采用传统1.0g剂量时,持续输注3h给药方式对体温的控制、临床治疗疗效以及细菌清除方面优于持续输注30min给药方式;而每8h应用美罗培南0.5g持续输注3h与每8h应用美罗培南1.0g持续输注30min相比具有非劣效性。

Therapeutic Effects of Adminstration Time of Meropenem on Pseudomonas Aeruginosa Infections

Objective To investigate the therapeutic effects and safety of the administration time of mero- penem infusion in patients with moderate and severe pseudomonas aeruginosa infections. Methods From June 2009 to September 2010,51 patients aged 18-60 years ,who were clinically diagnosed with moderate and severe pseudomonas aeruginosa infections and given meropenem in our hospital were enrolled in the study. After obtaining informed consent, they were randomly divided into three groups： high-dose for 30 rain group （group A）,high-dose for 3 h group （group B） and low-dose for 3 h group （group C）,with 17 patients in each group. Observations were conducted on the clinical efficacy and side effects during treatment of the three groups. The primary efficacy criteria were changes after body temperature and white blood cell count of 72 hours of meropenem administration. The secondary efficacy criteria included antibiotic clinical efficacy and bacteriological efficacy. The safety assessments included adverse events and the occurrence of adverse reaction rate calculation. Results After 72 hours of meropenem administration, no significant difference was observed on white blood cell counts of the three groups（P〉0.05） ;compared with group A, the temperature in group B and group C significantly dereased （P〈0.05） ;no other significant difference was obeserved of the group A and group C（P〉0.05）. On the withdrawal day, the clinical efficiency and bacterial clearance rate were group B than those in group A and group C（P〈0.05） ;no other significant difference was observed of group A and group C（P〉0.05）. Conclusion Compared with mero- penem continuous infusion by 1.0 g doses for 30 minutes,treatment of 1.0 g doses of meropenem continuous infusion for 3 hours was superior in temperature control, clinical effect and bacterial clearance. Compared with meropenem continuous infusion by 1.0 g doses for 30 minutes every 8 hours,administration of 500mg doses of meropenem continuous infusion for 3 hours every 8 hours indicates non-inferiority in temperature control, clinical effect and bacterial clearance.