Yang Yang, Lu Yang, He Xin, Zhao Hongwei, Wang Donghao, Wang Wanhua
1 Department of Anesthesia, Tianjin Medical University Cancer Institute and Hospital , National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China .
2 Intensive Care Unit, Tianjin Medical University Cancer Institute and Hospital , National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China .
Surg Infect (Larchmt). 2017 Feb/Mar;18(2):99-104. doi: 10.1089/sur.2016.087. Epub 2016 Oct 3.
This study was conducted to observe the clinical efficacy of long-term piperacillin-tazobactam (TZP) infusion and identify the factors affecting its curative effect against pneumonia in patients who had undergone surgery for abdominal tumor.
The 100 patients were divided into four clinical groups according to the severity of their infection: Simple pneumonia, pneumonia with pleural effusion, pneumonia and atelectasis, and severe pneumonia. Each group of patients was then divided into control and treatment groups using a completely random design. The control group received TZP as a regular infusion, and the treatment group received TZP as a long-term infusion. The cure time in the different groups was compared according to the administration regimen, and stratified analysis was carried out to identify the efficacy factors of long-term TZP infusion for patients with each kind of pneumonia.
The average cure time for TZP differed significantly among the groups. In particular, the average cure times in the simple pneumonia, pneumonia with pleural effusion, pneumonia and atelectasis, and severe pneumonia groups were 6.800 ± 0.342, 7.320 ± 0.304, 10.840 ± 0.571, and 15.942 ± 0.973 d (p < 0.001). In each group, the usage time of antibiotics in the treatment groups was significantly shorter than in the control group (8.87 ± 0.64 vs. 15.95 ± 2.02 d; p < 0.001). The cure times (d) for simple pneumonia and pneumonia and atelectasis were conspicuously lower in the treatment groups than in the control group (5.667 ± 0.256 vs. 7.846 ± 0.451; p < 0.001; 9.667 ± 1.432 vs. 11.923 ± 0.947; p = 0.024). The factors associated with continuous treatment effectiveness were being male, age <70 years, Acute Physiology and Chronic Health Evaluation score ≥17 points, minimum inhibitory concentration of the pathogen 8 mcg/mL, oxygenation index >200 mm Hg, serum procalcitonin concentration >4 ng/mL, and serum albumin <25 g/L.
Long-term TZP infusion exhibited better clinical efficacy than did traditional treatment in patients with pneumonia after abdominal tumor surgery.
本研究旨在观察长期输注哌拉西林 - 他唑巴坦（TZP）的临床疗效，并确定影响其对腹部肿瘤手术后肺炎患者治疗效果的因素。
将100例患者根据感染严重程度分为四个临床组：单纯性肺炎、肺炎伴胸腔积液、肺炎合并肺不张和重症肺炎。然后采用完全随机设计将每组患者分为对照组和治疗组。对照组接受常规输注TZP，治疗组接受长期输注TZP。根据给药方案比较不同组的治愈时间，并进行分层分析以确定长期输注TZP对每种肺炎患者的疗效因素。
TZP的平均治愈时间在各组之间存在显著差异。特别是，单纯性肺炎、肺炎伴胸腔积液、肺炎合并肺不张和重症肺炎组的平均治愈时间分别为6.800±0.342、7.320±0.304、10.840±0.571和15.942±0.973天（p<0.001）。在每组中，治疗组抗生素使用时间明显短于对照组（8.87±0.64天对15.95±2.02天；p<0.001）。治疗组中单纯性肺炎和肺炎合并肺不张的治愈时间（天）明显低于对照组（5.667±0.256对7.846±0.451；p<0.001；9.667±1.432对11.923±0.947；p = 0.024）。与持续治疗效果相关的因素为男性、年龄<70岁、急性生理与慢性健康状况评分≥17分、病原体最低抑菌浓度8 mcg/mL、氧合指数>200 mmHg、血清降钙素原浓度>4 ng/mL以及血清白蛋白<25 g/L。
对于腹部肿瘤手术后肺炎患者，长期输注TZP比传统治疗具有更好的临床疗效。
