目的 观察替加环素联合美罗培南治疗重症感染的临床疗效。方法 选取2013年2月—2015年6月青海省人民医院收治的重症感染患者100例,随机分为对照组和治疗组,每组各50例。对照组患者在基础治疗上静脉滴注注射用美罗培南,1 g/次,3次/d。治疗组在对照组基础上静脉滴注注射用替加环素,首次剂量100 mg/次,之后50 mg/次,2次/d。两组患者均连续治疗7 d。观察两组的临床疗效,同时比较两组细菌培养转阴时间。比较两组治疗前后体温、收缩压(SBP)、舒张压(DBP)、呼吸频率、心率、血红蛋白(Hb)、白细胞(WBC)、血小板(PLT)、降钙素原(PCT)、C反应蛋白(CRP)、乳酸(LA)的变化情况。结果 治疗后,对照组和治疗组的总有效率分别为82.0%、96.0%,两组比较差异具有统计学意义(P< 0.05)。治疗后,两组患者的体温、呼吸频率和心率均明显下降,SBP明显上升,同组治疗前后比较差异具有统计学意义(P< 0.05)。治疗后,治疗组的体温、心率显著低于对照组,且治疗组患者的细菌培养转阴时间显著短于对照组,两组比较差异具有统计学意义(P< 0.05)。治疗后,两组患者Hb、PLT均显著升高,WBC、CRP、PCT和LA均明显降低,同组治疗前后差异有统计学意义(P< 0.05);治疗后,治疗组WBC、CRP和PCT的改善程度优于对照组,两组比较差异具有统计学意义(P< 0.05)。结论 替加环素联合美罗培南治疗重症感染具有较好的临床疗效,可有效控制患者的感染及炎症反应,具有一定的临床推广应用价值。

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.