中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2013年
8期
479-483
,共5页
吕扬%闫昭%王东浩%董伟林%杨洋%夏睿
呂颺%閆昭%王東浩%董偉林%楊洋%夏睿
려양%염소%왕동호%동위림%양양%하예
哌拉西林/他唑巴坦%革兰阴性菌%最低抑菌浓度%延长输注时间%医院获得性肺炎
哌拉西林/他唑巴坦%革蘭陰性菌%最低抑菌濃度%延長輸註時間%醫院穫得性肺炎
고랍서림/타서파탄%혁란음성균%최저억균농도%연장수주시간%의원획득성폐염
Piperacillin/tazobactam%Gram negative bacteria%Minimum inhibitory concentration%Prolonged infusion time%Hospital acquired pneumonia
目的 观察哌拉西林/他唑巴坦(TZP)延长输注时间治疗医院获得性肺炎(HAP)患者的血药浓度并评价临床疗效.方法 选取2012年3月1日至10月31日收入本院重症监护病房(ICU)HAP患者50例,其细菌学药敏结果提示TZP最低抑菌浓度(MIC)值为8mg/L或16 mg/L,按完全随机化方法分为治疗组(25例)和对照组(25例),对照组治疗方案为TZP 4.5 g,6h间断给药1次,每次30 min内静脉滴注完成；治疗组输注方案为TZP 4.5 g,6h间断给药1次,输液泵持续静脉泵入3h.比较两组患者用药后3d急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、临床肺感染评分(CPIS)和降钙素原(PCT)水平；统计两组治疗成功率、补救治疗率、抗菌药物费用；于给药开始0.5、1、2、3、4、6h取血,用超高效液相色谱法-串联质谱(UPLC-MS)分别测定哌拉西林、他唑巴坦血药浓度.结果 用药3d后治疗组PCT(μg/L∶2.16±0.17比4.77±0.25)、CPIS(分,6.21±1.14比6.92±1.35)及补救治疗率(12.0％比52.0％)远远低于对照组(P＜0.05或P＜0.01),APACHEⅡ评分(分)略低于对照组(21.38±7.37比22.15±5.46,P＞0.05).经积极补救治疗后,治疗组与对照组患者治疗成功率(88.0％比80.0％)和复发率(4.2％比7.7％)比较差异均无统计学意义(均P＞0.05),但治疗组抗菌药物使用费用(元)明显低于对照组(4330.38±1087.24比5506.15±1361.73,P＜0.01),抗菌药物疗程(d)明显短于对照组(6.00±1.05比8.20±1.03,P＜0.01).监测铜绿假单胞菌、大肠埃希菌及肺炎克雷伯菌肺炎亚种3种细菌感染,治疗组给药0.5～6 h TZP血药浓度均大于MIC水平,但对照组在给药2～3h后TZP血药浓度已降至MIC以下.治疗组血药浓度高于MIC持续时间占给药间隔的百分比(％T＞MIC)平均为86.82％,而对照组％T＞MIC平均42.84％.结论 使用TZP延长输注时间的给药方案应用于由较高MIC值的革兰阴性菌所致的HAP,其血药浓度更加稳定,临床疗效确切,治疗费用少.
目的 觀察哌拉西林/他唑巴坦(TZP)延長輸註時間治療醫院穫得性肺炎(HAP)患者的血藥濃度併評價臨床療效.方法 選取2012年3月1日至10月31日收入本院重癥鑑護病房(ICU)HAP患者50例,其細菌學藥敏結果提示TZP最低抑菌濃度(MIC)值為8mg/L或16 mg/L,按完全隨機化方法分為治療組(25例)和對照組(25例),對照組治療方案為TZP 4.5 g,6h間斷給藥1次,每次30 min內靜脈滴註完成；治療組輸註方案為TZP 4.5 g,6h間斷給藥1次,輸液泵持續靜脈泵入3h.比較兩組患者用藥後3d急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、臨床肺感染評分(CPIS)和降鈣素原(PCT)水平；統計兩組治療成功率、補救治療率、抗菌藥物費用；于給藥開始0.5、1、2、3、4、6h取血,用超高效液相色譜法-串聯質譜(UPLC-MS)分彆測定哌拉西林、他唑巴坦血藥濃度.結果 用藥3d後治療組PCT(μg/L∶2.16±0.17比4.77±0.25)、CPIS(分,6.21±1.14比6.92±1.35)及補救治療率(12.0％比52.0％)遠遠低于對照組(P＜0.05或P＜0.01),APACHEⅡ評分(分)略低于對照組(21.38±7.37比22.15±5.46,P＞0.05).經積極補救治療後,治療組與對照組患者治療成功率(88.0％比80.0％)和複髮率(4.2％比7.7％)比較差異均無統計學意義(均P＞0.05),但治療組抗菌藥物使用費用(元)明顯低于對照組(4330.38±1087.24比5506.15±1361.73,P＜0.01),抗菌藥物療程(d)明顯短于對照組(6.00±1.05比8.20±1.03,P＜0.01).鑑測銅綠假單胞菌、大腸埃希菌及肺炎剋雷伯菌肺炎亞種3種細菌感染,治療組給藥0.5～6 h TZP血藥濃度均大于MIC水平,但對照組在給藥2～3h後TZP血藥濃度已降至MIC以下.治療組血藥濃度高于MIC持續時間佔給藥間隔的百分比(％T＞MIC)平均為86.82％,而對照組％T＞MIC平均42.84％.結論 使用TZP延長輸註時間的給藥方案應用于由較高MIC值的革蘭陰性菌所緻的HAP,其血藥濃度更加穩定,臨床療效確切,治療費用少.
목적 관찰고랍서림/타서파탄(TZP)연장수주시간치료의원획득성폐염(HAP)환자적혈약농도병평개림상료효.방법 선취2012년3월1일지10월31일수입본원중증감호병방(ICU)HAP환자50례,기세균학약민결과제시TZP최저억균농도(MIC)치위8mg/L혹16 mg/L,안완전수궤화방법분위치료조(25례)화대조조(25례),대조조치료방안위TZP 4.5 g,6h간단급약1차,매차30 min내정맥적주완성；치료조수주방안위TZP 4.5 g,6h간단급약1차,수액빙지속정맥빙입3h.비교량조환자용약후3d급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、림상폐감염평분(CPIS)화강개소원(PCT)수평；통계량조치료성공솔、보구치료솔、항균약물비용；우급약개시0.5、1、2、3、4、6h취혈,용초고효액상색보법-천련질보(UPLC-MS)분별측정고랍서림、타서파탄혈약농도.결과 용약3d후치료조PCT(μg/L∶2.16±0.17비4.77±0.25)、CPIS(분,6.21±1.14비6.92±1.35)급보구치료솔(12.0％비52.0％)원원저우대조조(P＜0.05혹P＜0.01),APACHEⅡ평분(분)략저우대조조(21.38±7.37비22.15±5.46,P＞0.05).경적겁보구치료후,치료조여대조조환자치료성공솔(88.0％비80.0％)화복발솔(4.2％비7.7％)비교차이균무통계학의의(균P＞0.05),단치료조항균약물사용비용(원)명현저우대조조(4330.38±1087.24비5506.15±1361.73,P＜0.01),항균약물료정(d)명현단우대조조(6.00±1.05비8.20±1.03,P＜0.01).감측동록가단포균、대장애희균급폐염극뢰백균폐염아충3충세균감염,치료조급약0.5～6 h TZP혈약농도균대우MIC수평,단대조조재급약2～3h후TZP혈약농도이강지MIC이하.치료조혈약농도고우MIC지속시간점급약간격적백분비(％T＞MIC)평균위86.82％,이대조조％T＞MIC평균42.84％.결론 사용TZP연장수주시간적급약방안응용우유교고MIC치적혁란음성균소치적HAP,기혈약농도경가은정,림상료효학절,치료비용소.
Objective To observe the serum concentration and evaluate clinical efficacy of piperacillin/tazobactam (TZP) prolonged infusion time in treatment of hospital acquired pneumonia (HAP).Methods Fifty HAP patients admitted to intensive care unit (ICU) from March 1 to October 31,2012 were enrolled.The bacterial drug sensitivity results showed that the minimum inhibitory concentration (MIC) of TZP was 8 mg/L or 16 mg/L.According to completely randomized grouping method,the patients were divided into treatment group (n =25) and control group (n=25).The therapeutic regimen in control group was TZP 4.5 g,in regular infusion every 6 hours and finished in 30 minutes; the treatment group was TZP 4.5 g,in prolonged infusion every 6 hours by using infusion pump for continuous intravenous infusion 3 hours.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,clinical pulmonary infection score (CPIS) and procalcitonin (PCT) level were compared between the two groups 3 days after treatment.The treatment success rate,remedial treatment rate,antibiotic costs were recorded in both groups.Blood specimen was collected at 0.5,1,2,3,4,6 hours at the beginning of administration,and the blood drug concentration of piperacillin and tazobactam was determined using ultra performance liquid chromatography-tandem mass spectrometry (UPLC-MS).Results The PCT (μg/L:2.16 ± 0.17 vs.4.77 ± 0.25),CPIS score (6.21 ± 1.14 vs.6.92 ± 1.35) and remedial treatment rate (12.0％ vs.52.0％) of the treatment group were significantly lower than those of the control group after administration for 3 days (P＜0.05 or P＜0.01),and APACHE Ⅱ score was slightly lower than that in control group (21.38 ± 7.37 vs.22.15 ± 5.46,P＞0.05).After active remedial treatment,there were no significant difference in the treatment success rate (88.0％ vs.80.0％) and relapse rate (4.2％ vs.7.7％) between treatment group and control group (both P＞0.05).But the antibiotic costs (Yuan) in treatment group were significantly lower than that of control group (4330.38 ± 1087.24 vs.5506.15 ± 1361.73,P＜0.01).The treatment course of antibacterials in treatment group was significantly shorter than that in control group (6.00 ± 1.05 vs.8.20 ± 1.03,P＜0.01).The infection by Pseudomonas aeruginosa,Escherichia coli and Klebsiella pneumoniae was monitored,TZP serum concentration administrated at 0.5-6 hours in the treatment group was higher than MIC,but in the control group,TZP blood concentration was lower than MIC after administration for 2-3 hours.In treatment group,the percentage of duration of blood drug level higher than MIC account for dosing interval (％T＞MIC) was 86.82％,while in the control group,the ％T＞MIC was 42.84％.Conclusion TZP prolonged the infusion time dosing regimens using in Gram negative bacteria induced by high MIC value of HAP have more stable plasma concentration,curative clinical effect and reduce the cost of treatment.
