延长美罗培南输注时间对老年脓毒症患者预后的影响

Influence of prolonging infusion time of meropenem on prognosis of elderly patients with sepsis

  • 摘要:
    目的 分析延长美罗培南输注时间对老年脓毒症患者预后的影响。
    方法 将111例老年脓毒症患者随机分为对照组55例和观察组56例。2组患者均给予美罗培南0.5 g静脉输注,对照组在30 min内输注完毕,观察组在60 min内输注完毕。比较2组患者临床指标水平、不良反应及多器官功能障碍综合征(MODS)发生率。根据院内21 d生存情况,将111例患者分为存活组88例和死亡组23例,采用二元Logistics回归模型分析影响老年脓毒症患者预后的因素。分析不同美罗培南输注时间与老年脓毒症患者预后的联系。
    结果 观察组抗生素使用时间、重症监护室(ICU)住院时间分别为(8.31±2.01)、(9.14±1.89) d, 短于对照组的(11.02±1.49)、(11.06±2.01) d, 差异有统计学意义(P < 0.05)。观察组不良反应总发生率为5.4%(3/56), 对照组为7.3%(4/55), 差异无统计学意义(P=0.678)。观察组MODS发生率为17.9%(10/56), 低于对照组的34.5%(19/55), 差异有统计学意义(P < 0.05)。111例患者中,院内21 d存活88例,死亡23例,病死率为20.7%。与存活组相比,死亡组血小板减少、乳酸增高、美罗培南输注时间为30 min的患者比率更高,差异有统计学意义(P < 0.05)。Logistics回归分析显示,血小板减少、乳酸增高、美罗培南输注时间(30 min)是老年脓毒症患者预后的危险因素(P < 0.05)。
    结论 将美罗培南输注时间延长至60 min可提高老年脓毒症患者康复效率,降低MODS发生率及预后不良的风险。

     

    Abstract:
    Objective To analyze the influence of prolonging infusion time of meropenem on prognosis of elderly patients with sepsis.
    Methods A total of 111 elderly patients with sepsis were randomly divided into control group (n=55) and observation group (n=56). Patients in both groups were conducted with intravenous infusion of 0.5 g meropenem, the control group completed infusion within 30 minutes, while the observation group completed infusion within 60 minutes. Clinical indexes, adverse reactions and incidence of multiple organ dysfunction syndrome (MODS) were compared between the two groups. According to the 21-day survival status in the hospital, the 111 patients were divided into survival group (n=88) and death group (n=23), and a binary Logistic regression model was used to analyze the factors affecting the prognosis of elderly patients with sepsis. Relationship between different infusion time of meropenem and prognosis of elderly patients with sepsis was analyzed.
    Results The time of antibiotic use and hospital stay in the Intensive Care Unit (ICU) in the observation group were (8.31±2.01) and (9.14±1.89) days respectively, which were significantly shorter than (11.02±1.49) and (11.06±2.01) days in the control group (P < 0.05). The overall incidence of adverse reactions was 5.4% (3/56) in the observation group, which showed no significant difference when compared to 7.3% (4/55) in the control group (P=0.678). The incidence of MODS was 17.9% (10/56) in the observation group, which was significantly lower than 34.5% (19/55) in the control group (P < 0.05). Out of 111 cases, 88 patients survived within 21 days in hospital, and 23 died with a mortality rate of 20.7%. Compared to the survival group, the death group had higher ratios of patients with decreased platelet count, increased lactate level and 30 minutes infusion time of meropenem, and there were significant differences between two groups (P < 0.05). Logistic regression analysis showed that decreased platelet count, increased lactate level and infusion time of meropenem (30 minutes) were the influencing factors for the prognosis of elderly patients with sepsis (P < 0.05).
    Conclusion Prolonging the infusion time of meropenem to 60 minutes can improve the rehabilitation efficiency of elderly patients with sepsis, and reduce the incidence of MODS and the risk of adverse prognosis.

     

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