目的 探討哌拉西林他唑巴坦負(fù)荷劑量兩步輸注與傳統(tǒng)延長輸注治療重癥監(jiān)護(hù)病房革蘭陰性菌（GNB）致重癥醫(yī)院獲得性肺炎（HAP）的臨床療效。方法 選擇2019年5月—2022年11月入住衡水市人民醫(yī)院重癥監(jiān)護(hù)病房（ICU）的多重耐藥革蘭陰性菌（GNB）致重癥醫(yī)院獲得性肺炎患者150例，按照隨機(jī)數(shù)字表分為對照組和治療組，每組各75例。對照組靜脈泵入注射用哌拉西林鈉他唑巴坦鈉，4.5 g加入生理鹽水100 mL，靜脈泵持續(xù)輸注3 h，1次/8 h。治療組靜脈泵入注射用哌拉西林鈉他唑巴坦鈉，4.5 g加入生理鹽水100 mL，前2.25 g采用靜脈泵在30 min內(nèi)輸注，后2.25 g采用靜脈泵在150 min內(nèi)持續(xù)輸注。兩組患者均治療7～14 d。觀察兩組患者臨床療效，比較治療前后兩組患者細(xì)菌清除率，臨床感染癥狀恢復(fù)時間，炎性指標(biāo)降鈣素原（PCT）、C反應(yīng)蛋白（CRP）和白細(xì)胞計數(shù)（WBC）水平，及住院時間、機(jī)械通氣時間和治療總費(fèi)用。結(jié)果 治療后，治療組臨床總有效率（85.33%）顯著高于對照組（70.67%，P＜0.05）。治療后，治療組細(xì)菌清除率（73.33%）顯著高于對照組（56.00%，P＜0.05）。治療后，治療組啰音消失時間、咳嗽咳痰消失時間和退熱時間均短于對照組（P＜0.05）；治療后，兩組WBC、PCT和CRP均顯著下降（P＜0.05），且治療組比對照組下降更顯著（P＜0.05）。治療后，治療組在住院時間、機(jī)械通氣時間和治療總費(fèi)用方面均明顯小于對照組（P＜0.05）。結(jié)論 哌拉西林他唑巴坦負(fù)荷劑量兩步輸注能顯著提高入住ICU病房GNB致重癥HAP的臨床療效和細(xì)菌清除率，能明顯縮短癥狀改善時間，從而縮短患者住院時間和降低治療費(fèi)用。

Objective To investigate the efficacy of piperacillin/tazobactam by two-step infusion with loading dose versus traditional extended infusion in the treatment of severe hospital-acquired pneumonia (HAP) caused by gram-negative bacteria (GNB) in ICU. Methods Patients (150 cases) with severe hospital acquired pneumonia caused by multi-drug resistant Gram-negative bacteria (GNB) in Hengshui People’s Hospital from May 2019 to November 2022 were divided into control and treatment group according to random number table, and each group had 75 cases. Patients in the control group were infusion administered with Piperacillin Sodium and Tazobactam Sodium for injection, 4.5 g added into normal saline 100 mL for 3 h, once every 8 h. Patients in the treatment group were infusion administered with Piperacillin Sodium and Tazobactam Sodium for injection, 4.5 g added into normal saline 100 mL, the first 2.25 g was infused within 30 min by intravenous pump, and the last 2.25 g was infused continuously within 150 min. Patients in two groups were treated for 7 — 14 d. After treatment, the clinical evaluation was evaluated, and the bacterial clearance rate, improvement time of clinical infection signs, the levels of inflammatory indexes WBC, PCT and CRP, and hospitalization time, mechanical ventilation time, and total treatment cost in two groups before and after treatment were compared. Results After treatment, the total clinical effective rate of the treatment group (85.33%) was significantly higher than that of the control group (70.67%, P < 0.05). After treatment, the bacterial clearance rate in the treatment group (73.33%) was significantly higher than that in the control group (56.00%, P< 0.05). After treatment, the disappearance time of rale, cough and sputum and body temperature recovery time in the treatment group were shorter than those in the control group (P< 0.05). After treatment, WBC, PCT and CRP in two groups were significantly decreased (P < 0.05), and the decrease in the treatment group was more significant than that in the control group (P < 0.05). After treatment, the treatment group showed significantly lower hospitalization time, mechanical ventilation time, and total treatment cost compared to the control group (P < 0.05). Conclusion Two-step infusion with loading dose of piperacillin and tazobactam can significantly improve the clinical efficacy and bacterial clearance rate of severe hospital-acquired pneumonia caused by gram-negative bacteria in ICU, and can significantly shorten the time of symptom improvement, thus shorten the time of hospitalization and reduce the cost of treatment.

R974

河北省醫(yī)學(xué)科學(xué)研究課題計劃項目（20220458）