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中华肺部疾病杂志(电子版)

中华肺部疾病杂志(电子版) ›› 2024, Vol. 17 ›› Issue (01) : 73 -77. doi: 10.3877/cma.j.issn.1674-6902.2024.01.014

论著

不同剂量亚胺培南西司他丁钠治疗重症肺炎的疗效分析
周璐1, 钱桂亮2,†(), 黄建1, 辛永利3   
  1. 1. 214000　江苏，无锡市康复医院老年康复科
    2. 214000　江苏，无锡市第二老年病医院呼吸内科
    3. 226003　江苏，南通市第一人民医院胸心外科
  • 收稿日期:2023-09-11 出版日期:2024-02-25
  • 通信作者: 钱桂亮
  • 基金资助:
    江苏省自然科学基金面上项目(BK20201491)

Effect analysis of different doses of imipenem/cilastatin sodium in the treatment of severe pneumonia

Lu Zhou1, Guiliang Qian2,†(), Jian Huang1, Yongli Xin3   

  1. 1. Department of Elderly Rehabilitation, Wuxi Rehabilitation Hospital, Wuxi 214000, China
    2. Department of Respiratory, Wuxi No.2 Geriatric Hospital, Wuxi 214000, China
    3. Depatment of cardiothoracic surgery, the First People′s Hospital of Nantong, Nantong 226003, China
  • Received:2023-09-11 Published:2024-02-25
  • Corresponding author: Guiliang Qian
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引用本文：

周璐, 钱桂亮, 黄建, 辛永利. 不同剂量亚胺培南西司他丁钠治疗重症肺炎的疗效分析[J]. 中华肺部疾病杂志(电子版), 2024, 17(01): 73-77.

Lu Zhou, Guiliang Qian, Jian Huang, Yongli Xin. Effect analysis of different doses of imipenem/cilastatin sodium in the treatment of severe pneumonia[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 73-77.

目的

分析不同剂量亚胺培南西司他丁钠治疗重症肺炎的疗效。

方法

选择2021年7月至2023年8月我院收治的58例重症肺炎患者为对象，根据治疗方法不同分为对照组27例与观察组31例。两组接受基础治疗。对照组接受低剂量1.0 g亚胺培南西司他丁钠治疗，观察组接受高剂量2.0 g亚胺培南西司他丁钠治疗，疗程10 d。比较两组肺功能、血气参数、临床疗效、血清学指标、病原菌清除率及不良反应。

结果

血清学指标，IL-8观察组和对照组治疗前/后[(0.47±0.06) vs. (0.46±0.05)比(0.21±0.03) vs. (0.28±0.04)ng/ml(P<0.05)]；CDL[(0.55±0.58) vs. (0.37±0.052)比(1.65±0.31) vs. (2.24±0.43)ng/L，(P<0.05)]；sICAM-1[(33.57±4.96) vs. (32.48±4.32)比(8.25±2.08) vs. (14.19±3.27)ng/L，(P<0.05)]。动脉血气参数，PaCO2观察组和对照组治疗前(83.57±7.22) vs. (82.43±7.68)mmHg，治疗后(56.38±5.07) vs. (67.23±6.15)mmHg(P<0.05)；PaO2两组治疗前(54.83±6.79) vs. (53.40±6.51)mmHg，治疗后(91.35±9.81) vs. (77.36±8.42)mmHg(P<0.05)，SaO2两组治疗前(85.26±6.64) vs. (86.77±6.24)%，治疗后(95.63±8.97) vs. (90.82±7.39)%(P<0.05)。两组最大呼气中段流量(maximum midexpiratory flow, MMF)、第1秒内用力呼气容积(forced expiratory volume within 1 second, FEV1)及用力肺活量(forced vital capacity, FVC)水平升高(P<0.05)，观察组FVC(2.99±0.48)L, FEV1(2.18±0.35)%, MMF(1.59±0.31)L/s高于对照组(P<0.05)。

结论

低剂量亚胺培南西司他丁钠相比，高剂量亚胺培南西司他丁钠治疗重症肺炎疗效确切，可改善患者肺功能与血气参数，减轻炎症反应，调节血清sICAM-1、CD40L水平，提高病原菌清除率。

关键词: 不同剂量, 亚胺培南西司他丁钠, 重症肺炎, 疗效, 不良反应
Objective

To analyze the efficacy of different doses of imipenem/cilastatin sodium in the treatment of severe pneumonia.

Methods

A total of 58 patients with severe pneumonia admitted to the hospital from July 2021 to August 2023 were selected and divided into a control group (27 cases) and an observation group (31 cases) according to different treatment methods. Both groups received basic treatment. The control group received low dose (1.0 g) of imipenem and cilastatin sodium, while the observation group received high dose (2.0 g) of imipenem and cilastatin sodium. Both groups were treated for 7 days. Lung function, blood gas indexes, clinical efficacy, serological indexes, pathogenic bacteria clearance and adverse reactions were compared in two groups.

Results

Serum indicators, IL-8 of observation and control groups before treatment(0.47±0.06) vs. (0.46±0.05), after treatment (0.21±0.03) vs. (0.28±0.04)ng/ml(P<0.05); sICAM-1 before treatment(33.57±4.96) vs. (32.48±4.32), after treatment(8.25±2.08) vs. (14.19±3.27)ng/L(P<0.05). Arterial blood gas parameters, PaCO2 of observation and control groups, before treatment(83.57±7.22) vs. (82.43±7.68)mmHg, after treatment(56.38±5.07) vs. (67.23±6.15)mmHg(P<0.05); PaO2 before treatment(54.83±6.79) vs. (53.40±6.51)mmHg, after treatment (91.35±9.81) vs. (77.36±8.42)mmHg(P<0.05); SaO2 before treatment(85.26±6.64) vs. (86.77±6.24)%, after treatment(95.63±8.97) vs. (90.82±7.39)%(P<0.05). After treatment, maximum mid-expiratory flow (MMF), forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) levels in 2 groups were increased (P<0.05), and those in observation group were higher [FVC(2.99±0.48)L, FEV1(2.18±0.35)%, MMF(1.59±0.31)L/s (P<0.05)].

Conclusion

Compared with low dose imipenem cilastatin sodium, high dose imipenem cilastatin sodium is effective in the treatment of severe pneumonia, can improve lung function and blood gas indexes, reduce inflammatory response, regulate serum sICAM-1 and CD40L levels, and increase the clearance rate of pathogenic bacteria, and is safe and reliable.

Key words: Different dose, Imipenem cilastatin sodium, Severe pneumonia, Curative effect, Adverse reaction
表1 两组重症肺炎患者血清学指标比较(±s)
组　别 例数 IL-8(ng/ml) CD40L(ng/L) sICAM-1(ng/L)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 31 0.47±0.06 0.21±0.03a 3.53±0.58 1.65±0.31a 33.57±4.69 8.25±2.08a
对照组 27 0.46±0.05 0.28±0.04a 3.75±0.52 2.24±0.43a 32.48±4.32 14.19±3.27a
t值   0.892 9.849 1.971 7.836 1.194 10.816
P值   0.375 0.000 0.052 0.000 0.236 0.000
表2 两组重症肺炎患者动脉血气参数结果(±s)
组　别 例数 PaCO2(mmHg) PaO2(mmHg) SaO2(%)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 31 83.57±7.22 56.38±5.07a 54.83±6.79 91.35±9.81a 85.26±6.69 95.63±8.97a
对照组 27 82.43±7.68 67.23±6.15a 53.40±6.51 77.36±8.42a 86.77±6.24 90.82±7.39a
t值   0.757 9.559 1.062 7.545 1.153 2.883
P值   0.451 0.000 0.291 0.000 0.252 0.005
表3 两组重症肺炎患者肺功能指标比较(±s)
组　别 例数 FVC(L) FEV1(%) MMF(L/s)
治疗前 治疗后 治疗前 治疗后 治疗前 治疗后
观察组 31 1.79±0.32 2.99±0.48a 1.12±0.18 2.18±0.35a 0.33±0.04 1.59±0.31a
对照组 27 1.72±0.29 2.47±0.40a 1.19±0.17 1.63±0.26a 0.34±0.05 0.96±0.21a
t值   1.131 5.799 1.975 8.770 1.097 11.678
P值   0.261 0.000 0.051 0.000 0.275 0.000
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