美罗培南联合莫西沙星对慢性阻塞性肺疾病并发感染性肺炎患者的影响
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摘要
目的探讨美罗培南联合莫西沙星对慢性阻塞性肺疾病(COPD)并发感染性肺炎患者的影响。方法选取2016年4月—2018年3月内蒙古医科大学附属医院收治的COPD并发感染性肺炎患者68例,采用随机数字表法分为对照组和观察组,每组34例。对照组患者在常规治疗及经验性抗感染治疗基础上给予莫西沙星治疗,观察组患者在常规治疗及经验性抗感染治疗基础上给予美罗培南联合莫西沙星治疗;两组患者均持续治疗7 d。比较两组患者临床疗效、临床症状恢复正常/消失时间、病原菌清除率、治疗前后肺功能指标〔包括最大自主通气量占预计值百分比(MVV%pred)、最大呼气中期流速(MMEF)和第1秒用力呼气容积占预计值百分比(FEV_1%pred)〕及炎性因子〔包括降钙素原(PCT)、肿瘤坏死因子α(TNF-α)和超敏C反应蛋白(hs-CRP)〕水平,并观察两组患者治疗期间不良反应发生情况。结果 (1)观察组患者临床疗效优于对照组(P<0.05)。(2)观察组患者体温恢复正常时间、白细胞计数恢复正常时间、湿啰音消失时间、咳嗽消失时间短于对照组(P<0.05)。(3)观察组患者病原菌清除率高于对照组(P<0.05)。(4)治疗前两组患者MVV%pred、MMEF、FEV1%pred比较,差异无统计学意义(P>0.05);治疗后观察组患者MVV%pred、FEV1%pred高于对照组,MMEF快于对照组(P<0.05)。(5)治疗前两组患者PCT、TNF-α、hs-CRP水平比较,差异无统计学意义(P>0.05);治疗后观察组患者PCT、TNF-α、hsCRP水平低于对照组(P<0.05)。(6)两组患者治疗期间不良反应发生率比较,差异无统计学意义(P>0.05)。结论美罗培南联合莫西沙星治疗COPD并发感染性肺炎患者的疗效确切,可有效缩短临床症状恢复正常/消失时间,提高病原菌清除率,改善肺功能,减轻炎性反应,且安全性较高。
Objective To investigate the impact of meropenem combined with moxifloxacin on COPD patients complicated with infectious pneumonia. Methods A total of 68 COPD patients complicated with infectious pneumonia were selected in the Affiliated Hospital of Inner Mongolia Medical University from April 2016 to March 2018,and they were divided into control group and observation group according to random number table method,with 34 cases in each group. Based on conventional treatment and empirical anti-infective therapy,patients in control group received moxifloxacin,while patients in observation group received meropenem combined with moxifloxacin;both groups continuously treated for 7 days. Clinical effect,recovery/disappearance time of clinical symptoms,clearance rate of pathogen,index of pulmonary function(including MVV%pred,MMEF and FEV_1% pred)and inflammatory cytokines(including PCT,TNF-α and hs-CRP)before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during treatment. Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)Recovery time of temperature and WBC,disappearance time of moist crackles and cough in observation group were statistically significantly shorter than those in control group(P<0.05).(3)Clearance rate of pathogen in observation group was statistically significantly higher than that in control group(P<0.05).(4)No statistically significant difference of MVV%pred,MMEF or FEV1%pred was found between the two groups before treatment(P>0.05);after treatment, MVV%pred,FEV1%pred in observation group were statistically significantly higher than those in control group,while MMEF in observation group was statistically significantly higher than that in control group(P<0.05).(5)No statistically significant difference of PCT,TNF-α or hs-CRP was found between the two groups before treatment(P>0.05),while PCT,TNF-α and hs-CRP in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(6)No statistically significant difference of incidence of adverse reactions was found between the two groups during treatment(P>0.05).Conclusion Meropenem combined with moxifloxacin has certain clinical effect in treating COPD patients complicated with infectious pneumonia,can effectively shorten the recovery/disappearance time of clinical symptoms,improve the clearance rate of pathogen and pulmonary function,relieve the inflammatory reaction,with relatively high safety.
Objective To investigate the impact of meropenem combined with moxifloxacin on COPD patients complicated with infectious pneumonia. Methods A total of 68 COPD patients complicated with infectious pneumonia were selected in the Affiliated Hospital of Inner Mongolia Medical University from April 2016 to March 2018,and they were divided into control group and observation group according to random number table method,with 34 cases in each group. Based on conventional treatment and empirical anti-infective therapy,patients in control group received moxifloxacin,while patients in observation group received meropenem combined with moxifloxacin;both groups continuously treated for 7 days. Clinical effect,recovery/disappearance time of clinical symptoms,clearance rate of pathogen,index of pulmonary function(including MVV%pred,MMEF and FEV_1% pred)and inflammatory cytokines(including PCT,TNF-α and hs-CRP)before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during treatment. Results(1)Clinical effect in observation group was statistically significantly better than that in control group(P<0.05).(2)Recovery time of temperature and WBC,disappearance time of moist crackles and cough in observation group were statistically significantly shorter than those in control group(P<0.05).(3)Clearance rate of pathogen in observation group was statistically significantly higher than that in control group(P<0.05).(4)No statistically significant difference of MVV%pred,MMEF or FEV1%pred was found between the two groups before treatment(P>0.05);after treatment, MVV%pred,FEV1%pred in observation group were statistically significantly higher than those in control group,while MMEF in observation group was statistically significantly higher than that in control group(P<0.05).(5)No statistically significant difference of PCT,TNF-α or hs-CRP was found between the two groups before treatment(P>0.05),while PCT,TNF-α and hs-CRP in observation group were statistically significantly lower than those in control group after treatment(P<0.05).(6)No statistically significant difference of incidence of adverse reactions was found between the two groups during treatment(P>0.05).Conclusion Meropenem combined with moxifloxacin has certain clinical effect in treating COPD patients complicated with infectious pneumonia,can effectively shorten the recovery/disappearance time of clinical symptoms,improve the clearance rate of pathogen and pulmonary function,relieve the inflammatory reaction,with relatively high safety.
引文
[1]张福红,王英,魏铁垒,等.美罗培南联合莫西沙星治疗慢性阻塞性肺疾病并发感染性肺炎患者肺部状态及炎性应激的影响研究[J].中华医院感染学杂志,2016,26(23):5416-5417,5479.DOI:10.11816/cn.ni.2016-162045.
[2]李玲,张华茹,谭于飞,等.慢性阻塞性肺疾病患者肺功能损害严重程度与肺部感染相关性研究[J].临床心身疾病杂志,2018,25(2):46-48.DOI:10.3969/j.issn.1672-187X.2018.02.013.
[3]张红,金路,葛卫红,等.不同生理病理状态下美罗培南药动学/药效学差异性研究进展[J].中国感染与化疗杂志,2016,16(1):92-98.DOI:10.16718/j.1009-7708.2016.01.021.
[4]王里,王素萍,陈倞倞.莫西沙星治疗老年呼吸道感染的有效性与安全性评价[J].中华医院感染学杂志,2015,25(10):2216-2218.DOI:10.11816/cn.ni.2015-150265.
[5]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[6]瞿介明,曹彬.中国成人社区获得性肺炎诊断和治疗指南(2016年版)修订要点[J].中华结核和呼吸杂志,2016,39(4):241-242.DOI:10.3760/cma.j.issn.1001-0939.2016.04.001.
[7]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版)[M].北京:人民卫生出版社,2015:1-15.
[8]齐慧生,刘宝欣,郭红,等.美罗培南联合莫西沙星治疗慢性阻塞性肺疾病感染性肺炎的疗效与安全性研究[J].中华医院感染学杂志,2016,26(9):1967-1969.DOI:10.11816/cn.ni.2016-153835.
[9]周宇麒,张天托.慢性阻塞性肺疾病肺部感染的诊疗进展[J].临床内科杂志,2016,33(12):797-800.DOI:10.3969/j.issn.1001-9057.2016.12.001.
[10]刘畅,周向东.莫西沙星对肺结核患者血清游离氨基酸及炎症因子作用分析[J].内科急危重症杂志,2017,23(4):298-300.DOI:10.11768/nkjwzzzz20170411.
[11]贾王平,郭代红,朱曼,等.莫西沙星相关性肝损害及血细胞减少的自动监测研究[J].中国药物应用与监测,2016,13(5):306-309.
[12]赵嘉,韩朋飞,张丽.美罗培南联合莫西沙星对COPD并发感染性肺炎患者肺功能的影响[J].贵州医药,2018,42(5):585-586.
[13]宋晓菲,翁伟,陈继中.降钙素原联合C反应蛋白检测在诊断细菌感染性疾病中的应用[J].临床输血与检验,2016,18(1):35-38.DOI:10.3969/j.issn.1671-2587.2016.01.012.
[14]史秋涛,谷志远.肿瘤坏死因子-α与种植体周围炎炎性骨吸收[J].口腔医学研究,2015,31(7):745-747.DOI:10.13591/j.cnki.kqyx.2015.31.007.
[15]王军,凌欣,张冬新.血清PCT、hs-CRP和TNF-α水平对老年急性脑血管病诱发多器官功能不全综合征的预测价值[J].河北医药,2017,39(3):325-327.DOI:10.3969/j.issn.1002-7386.2017.03.001.
[2]李玲,张华茹,谭于飞,等.慢性阻塞性肺疾病患者肺功能损害严重程度与肺部感染相关性研究[J].临床心身疾病杂志,2018,25(2):46-48.DOI:10.3969/j.issn.1672-187X.2018.02.013.
[3]张红,金路,葛卫红,等.不同生理病理状态下美罗培南药动学/药效学差异性研究进展[J].中国感染与化疗杂志,2016,16(1):92-98.DOI:10.16718/j.1009-7708.2016.01.021.
[4]王里,王素萍,陈倞倞.莫西沙星治疗老年呼吸道感染的有效性与安全性评价[J].中华医院感染学杂志,2015,25(10):2216-2218.DOI:10.11816/cn.ni.2015-150265.
[5]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核和呼吸杂志,2013,36(4):255-264.DOI:10.3760/cma.j.issn.1001-0939.2013.04.007.
[6]瞿介明,曹彬.中国成人社区获得性肺炎诊断和治疗指南(2016年版)修订要点[J].中华结核和呼吸杂志,2016,39(4):241-242.DOI:10.3760/cma.j.issn.1001-0939.2016.04.001.
[7]《抗菌药物临床应用指导原则》修订工作组.抗菌药物临床应用指导原则(2015年版)[M].北京:人民卫生出版社,2015:1-15.
[8]齐慧生,刘宝欣,郭红,等.美罗培南联合莫西沙星治疗慢性阻塞性肺疾病感染性肺炎的疗效与安全性研究[J].中华医院感染学杂志,2016,26(9):1967-1969.DOI:10.11816/cn.ni.2016-153835.
[9]周宇麒,张天托.慢性阻塞性肺疾病肺部感染的诊疗进展[J].临床内科杂志,2016,33(12):797-800.DOI:10.3969/j.issn.1001-9057.2016.12.001.
[10]刘畅,周向东.莫西沙星对肺结核患者血清游离氨基酸及炎症因子作用分析[J].内科急危重症杂志,2017,23(4):298-300.DOI:10.11768/nkjwzzzz20170411.
[11]贾王平,郭代红,朱曼,等.莫西沙星相关性肝损害及血细胞减少的自动监测研究[J].中国药物应用与监测,2016,13(5):306-309.
[12]赵嘉,韩朋飞,张丽.美罗培南联合莫西沙星对COPD并发感染性肺炎患者肺功能的影响[J].贵州医药,2018,42(5):585-586.
[13]宋晓菲,翁伟,陈继中.降钙素原联合C反应蛋白检测在诊断细菌感染性疾病中的应用[J].临床输血与检验,2016,18(1):35-38.DOI:10.3969/j.issn.1671-2587.2016.01.012.
[14]史秋涛,谷志远.肿瘤坏死因子-α与种植体周围炎炎性骨吸收[J].口腔医学研究,2015,31(7):745-747.DOI:10.13591/j.cnki.kqyx.2015.31.007.
[15]王军,凌欣,张冬新.血清PCT、hs-CRP和TNF-α水平对老年急性脑血管病诱发多器官功能不全综合征的预测价值[J].河北医药,2017,39(3):325-327.DOI:10.3969/j.issn.1002-7386.2017.03.001.