Citation: | LI Dongfeng, LI Yalin, SUN Zhenkang, YAN Feng, WANG Xiumin, LI Hao. Influence of prolonging infusion time of meropenem on prognosis of elderly patients with sepsis[J]. Journal of Clinical Medicine in Practice, 2023, 27(15): 115-119. DOI: 10.7619/jcmp.20232026 |
To analyze the influence of prolonging infusion time of meropenem on prognosis of elderly patients with sepsis.
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.
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).
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.
[1] |
张庆, 蔡阳平, 刘红栓, 等. 附子理中汤干预广谱抗生素治疗脓毒症时药物性肠道菌群失调的疗效观察[J]. 中国中医急症, 2022, 31(2): 287-290. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202202026.htm
|
[2] |
ASNER S A, DESGRANGES F, SCHRIJVER I T, et al. Impact of the timeliness of antibiotic therapy on the outcome of patients with sepsis and septic shock[J]. J Infect, 2021, 82(5): 125-134. doi: 10.1016/j.jinf.2021.03.003
|
[3] |
李怡, 李洁, 桂万弟, 等. 基于PK/PD效应相关的目标获得概率论述美罗培南延长输注给药的适宜性[J]. 中国医院药学杂志, 2020, 40(6): 681-687. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYZ202006018.htm
|
[4] |
中国医师协会急诊医师分会, 中国研究型医院学会休克与脓毒症专业委员会. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 中国急救医学, 2018, 38(9): 741-756. https://www.cnki.com.cn/Article/CJFDTOTAL-GRYX201901001.htm
|
[5] |
SEYMOUR C W, LIU V X, IWASHYNA T J, et al. Assessment of clinical criteria for Sepsis: for the third international consensus definitions for Sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8): 762-774. doi: 10.1001/jama.2016.0288
|
[6] |
常青, 陈豆豆, 吴魏芹, 等. 乌司他丁联合丹红注射液对脓毒症患者的疗效以及对sTREM-1、HBP水平及th17/treg的影响[J]. 河北医科大学学报, 2020, 41(8): 899-904. https://www.cnki.com.cn/Article/CJFDTOTAL-HBYX202008008.htm
|
[7] |
吕扬, 王东浩. 脓毒症发病机制及β受体阻滞剂用于早期脓毒症治疗的研究进展[J]. 中国中西医结合急救杂志, 2022, 29(1): 115-118.
|
[8] |
SHI S Y, ZHANG X D, YAO Z C, et al. Synergistic effect of the novel β-lactamase inhibitor BLI-489 combined with imipenem or meropenem against diverse carbapenemase-producing carbapenem-resistant Enterobacterales[J]. J Antimicrob Chemother, 2022, 77(5): 1301-1305.
|
[9] |
翟莎娜, 孙清海, 余永武, 等. 万古霉素联合美罗培南对PDRP患者疗效及血清TNF-α、PCT、IL-6水平和腹膜液WBC计数的影响[J]. 检验医学, 2022, 37(4): 360-364. https://www.cnki.com.cn/Article/CJFDTOTAL-SHYY202204011.htm
|
[10] |
成群, 吴佳妮, 孙建鹰, 等. 优化两步输注美罗培南联合参麦注射液对重症感染患者血清感染指标、细菌清除率和T淋巴细胞亚群的影响[J]. 现代生物医学进展, 2021, 21(2): 388-392. https://www.cnki.com.cn/Article/CJFDTOTAL-SWCX202102043.htm
|
[11] |
闵玉娣, 权明桃, 陈妮, 等. 脓毒性休克患者发生急性肾损伤危险因素的Meta分析[J]. 河北医学, 2020, 26(3): 463-468. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX202003027.htm
|
[12] |
付海英, 黄马玉. 延长美罗培南输液时间治疗脓毒症休克合并急性肾功能不全患者的临床效果[J]. 中国急救复苏与灾害医学杂志, 2020, 15(9): 1081-1084. https://www.cnki.com.cn/Article/CJFDTOTAL-XYZL201601042.htm
|
[13] |
周南君, 汤展宏. 血小板减少症对脓毒症患者预后的影响: 系统回顾和Meta分析[J]. 中国实用内科杂志, 2021, 41(3): 238-242, 256. https://www.cnki.com.cn/Article/CJFDTOTAL-SYNK202103016.htm
|
[14] |
侯宇, 苏醒, 敖雪, 等. 血必净联合重组人血小板生成素治疗脓毒症相关性血小板减少症中的有效性及对TLR4、PF4、TPO的影响[J]. 临床和实验医学杂志, 2022, 21(12): 1276-1279. https://www.cnki.com.cn/Article/CJFDTOTAL-SYLC202212012.htm
|
[15] |
陶丽丽, 杨其霖, 陈维校. 入重症监护室时血乳酸水平对脓毒症患者急性肾损伤发生的预测价值[J]. 实用临床医药杂志, 2021, 25(14): 41-44, 53. doi: 10.7619/jcmp.20210726
|
[16] |
罗勇, 王伟, 张鑫, 等. 血乳酸对2型糖尿病相关脓毒症患者预后的影响研究[J]. 检验医学与临床, 2022, 19(10): 1357-1359, 1363. https://www.cnki.com.cn/Article/CJFDTOTAL-JYYL202210016.htm
|
[17] |
RHEE C, HEIL E L. Toward more rational time-to-antibiotic metrics for suspected Sepsis[J]. Crit Care Med, 2021, 49(5): 858-860.
|