吴珊燕 王强 项志强

[摘要]目的 分析亚胺培南治疗卒中相关性肺炎的临床效果。方法 选取2015年8月～2017年8月我院呼吸内科重症监护室收治的90例卒中相关性肺炎患者作为研究对象，根据奇偶数分组法将其分为抗生素组和亚胺培南组，每组各45例。抗生素组患者单纯使用相应的抗生素治疗，亚胺培南组患者在抗生素治疗的基础上采用亚胺培南治疗。比较两组患者的体温恢复正常时间、抗生素使用时间、住院时间、细菌清除率，并比较两组患者的实验室检验结果[白细胞计数（WBC）、中性粒细胞数、C反应蛋白（CPR）、降钙素原（PCT）]，及治疗前后的美国国立卫生研究院卒中量表（NIHSS）评分。结果 治疗后，亚胺培南组患者的体温恢复正常时间为（3.10±0.56）d、抗生素使用时间为（5.15±1.64）d、住院时间为（11.30±3.21）d，均明显短于抗生素組的（3.89±1.12）d、（7.12±1.35）d、（13.47±2.18）d，差异有统计学意义（P<0.05）；亚胺培南组患者的细菌清除率为93.33%，高于抗生素组的75.56%，差异有统计学意义（P<0.05）。亚胺培南组患者的WBC为（6.74±1.52）×103/L、中性粒细胞数为（0.56±0.15）、CPR水平为（14.55±3.08）mg/L、PCT水平为（3.26±0.35）ng/ml，均低于抗生素组的（10.47±4.26）×103/L、（1.01±0.12）、（20.46±3.57）mg/L、（4.65±1.20）ng/ml，差异有统计学意义（P<0.05）。两组患者治疗前的NIHSS评分比较，差异无统计学意义（P>0.05）；两组患者治疗后的NIHSS评分均明显低于治疗前，差异有统计学意义（P<0.05）；亚胺培南组患者治疗后的NIHSS评分为（10.22±1.34）分，明显低于抗生素组的（12.31±1.50）分，差异有统计学意义（P<0.05）。结论 应用亚胺培南治疗卒中相关性肺炎的临床效果确切，可缩短病程和住院时间，有效清除细菌，值得在今后临床中推荐应用。

[关键词]卒中；相关性肺炎；亚胺培南；抗生素

[中图分类号] R743.33 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0147-04

[Abstract] Objective To analyze the clinical effect of Imipenem in the treatment of stroke-associated pneumonia. Methods A total of 90 patients with stroke-associated pneumonia admitted to the intensive care unit of department of respiratory medicine in our hospital from August 2015 to August 2017 were selected as study subjects. They were divided into the antibiotic group and the imipenem group according to the parity group method， with 45 cases in each group. Patients in the antibiotic group were treated with the corresponding antibiotics alone， and patients in the imipenem group were treated with Imipenem on the basis of antibiotic therapy. The time of normal temperature， antibiotic use， hospital stay， and the rate of bacterial clearance were compared between two groups. The results of laboratory test （white blood cell count [WBC]， neutrophil count， C-reactive protein [CRP]， procalcitonin [PCT]） and scores of national institute of health stroke scale （NIHSS） before and after treatment were compared between two groups. Results After treatment， the body temperature returned to normal time in the imipenem group was （3.10±0.56） d， the antibiotic use time was （5.15±1.64） d， and the time of hospital stay was （11.30±3.21） d， which were significantly shorter than those in the antibiotic group （[3.89±1.12] d， [7.12±1.35] d， [13.47±2.18] d）， and the differences were statistically significant （P<0.05）. The rate of bacterial clearance in the imipenem group was 93.33%， which was higher than that in the antibiotic group （75.56%）， and the difference was statistically significant （P<0.05）. The level of WBC in the imipenem group was （6.74±1.52）×103/L， the neutrophil count was （0.56±0.15）， the level of CPR was （14.55±3.08） mg/L， and the level of PCT was （3.26±0.35） ng/ml， which were lower than those in the antibiotic group （[10.47±4.26]×103/L， [1.01±0.12]， [20.46±3.57] mg/L， [4.65±1.20] ng/ml）， with statistically significant difference （P<0.05）. There was no significant difference in the score of NIHSS before treatment between two groups （P>0.05）. The NIHSS scores after treatment in two groups were significantly lower than those before treatment， and the differences were statistically significant （P<0.05）. The NIHSS scores after treatment in the imipenem group were （10.22±1.34） points， which were significantly lower than those in the antibiotic group （[12.31±1.50] points）， and the differences were statistically significant （P<0.05）. Conclusion The clinical effect of Imipenem in the treatment of stroke-associated pneumonia is definite. It can shorten the course of disease and time of hospitastay， effectively eliminate bacteria， which is worthy of clinical promotion and application.

[Key words] Stroke； Associated pneumonia； Imipenem； Antibiotics

目前为止，脑卒中属于人类死亡的主要原因之一[1]。随着脑卒中发病率的上升，患者住院治疗期间发生相关性肺炎的概率也在不断升高，极易增加患者的致残率以及死亡率[2]。卒中相关性肺炎（stroke associated pneumonia）属于卒中最为常见的并发症之一，主要发生于脑卒中患者之间，根据相关报道显示，存在卒中相关性肺炎的脑卒中患者死亡率非常高，是未并发卒中相关性肺炎患者的3倍。临床对于卒中相关性肺炎的治疗，除却抗生素，推薦亚胺培南药物治疗，其具有安全、有效等优势[3]。……