目的 觀察替加環(huán)素聯(lián)合美羅培南治療重癥感染的臨床療效。方法 選取2013年2月—2015年6月青海省人民醫(yī)院收治的重癥感染患者100例,隨機(jī)分為對(duì)照組和治療組,每組各50例。對(duì)照組患者在基礎(chǔ)治療上靜脈滴注注射用美羅培南,1 g/次,3次/d。治療組在對(duì)照組基礎(chǔ)上靜脈滴注注射用替加環(huán)素,首次劑量100 mg/次,之后50 mg/次,2次/d。兩組患者均連續(xù)治療7 d。觀察兩組的臨床療效,同時(shí)比較兩組細(xì)菌培養(yǎng)轉(zhuǎn)陰時(shí)間。比較兩組治療前后體溫、收縮壓(SBP)、舒張壓(DBP)、呼吸頻率、心率、血紅蛋白(Hb)、白細(xì)胞(WBC)、血小板(PLT)、降鈣素原(PCT)、C反應(yīng)蛋白(CRP)、乳酸(LA)的變化情況。結(jié)果 治療后,對(duì)照組和治療組的總有效率分別為82.0%、96.0%,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。治療后,兩組患者的體溫、呼吸頻率和心率均明顯下降,SBP明顯上升,同組治療前后比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。治療后,治療組的體溫、心率顯著低于對(duì)照組,且治療組患者的細(xì)菌培養(yǎng)轉(zhuǎn)陰時(shí)間顯著短于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。治療后,兩組患者Hb、PLT均顯著升高,WBC、CRP、PCT和LA均明顯降低,同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P< 0.05);治療后,治療組WBC、CRP和PCT的改善程度優(yōu)于對(duì)照組,兩組比較差異具有統(tǒng)計(jì)學(xué)意義(P< 0.05)。結(jié)論 替加環(huán)素聯(lián)合美羅培南治療重癥感染具有較好的臨床療效,可有效控制患者的感染及炎癥反應(yīng),具有一定的臨床推廣應(yīng)用價(jià)值。

Objective To investigate the clinical effect of tigecycline combined with meropenem in treatment of severe infection. Methods Patients (100 cases) with severe infection in Qinghai Provincial People's Hospital from February 2013 to June 2015 were randomly divided into control and treatment groups, and each group had 50 cases. The patients in the control group were iv administered with Meropenem for injection on the basis of foundation treatment, 1 g/time, three times daily. The patients in the treatment group were iv administered with Tigecycline for injection, and the first dosage was 100 mg/time, then 50 mg/time, twice daily. The patients in two groups were treated for 7 d. After treatment, the efficacy was evaluated, and culture negative time in the two groups was compared. The changes of body temperature, systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate, heart rate, hemoglobin (Hb), white blood cell (WBC), platelets (PLT), procalcitonin (PCT), C-reactive protein (CRP),and lactic acid (LA) before and after treatment in two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 82.0% and 96.0%, respectively, and there was difference between two groups (P < 0.05). After treatment, body temperature, respiratory rate, and heart rate in two groups were significantly decreased, and SBP were significantly increased, and the difference was statistically significant in the same group (P < 0.05). After treatment, body temperature and heart rate in the treatment group were lower than those in the control group, and culture negative time in the treatment group was shorter than that in the control group, with significant difference between two groups (P < 0.05). After treatment, Hb and PLT in two groups were significantly increased, WBC, CRP, PCT, and LA were significantly decreased, and the difference was statistically significant in the same group (P < 0.05).The improved degree of WBC, CRP and PCT in the treatment group was better than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Tigecycline combined with meropenem has good clinical efficacy in treatment of severe infection, and can effectively control the infection and inflammation, which has a certain clinical application value.