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[1]赵晓飞,王雪倩,张培芳.不同给药方案治疗医院获得性肺炎患者的疗效和成本分析及对血清SPA水平的影响[J].医学研究与战创伤救治(原医学研究生学报),2022,24(6):590-595.[doi:10.3969/j.issn.1672-271X.2022.06.007]
　ZHAO Xiao-fei,WANG Xue-qian,ZHANG Pei-fang.Efficacy and cost analysis of different administration schemes in the treatment of HAP patients and its effect on serum SPA level[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2022,24(6):590-595.[doi:10.3969/j.issn.1672-271X.2022.06.007]
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不同给药方案治疗医院获得性肺炎患者的疗效和成本分析及对血清SPA水平的影响()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第24卷
期数:
2022年6期
页码:
590-595
栏目:
临床研究
出版日期:
2023-01-18

文章信息/Info

Title:
Efficacy and cost analysis of different administration schemes in the treatment of HAP patients and its effect on serum SPA level
作者:
赵晓飞; 王雪倩; 张培芳
作者单位：054000邢台，邢台医学高等专科学校第二附属医院临床药学科（赵晓飞），呼吸与危重症医学科（王雪倩），护理部（张培芳）
Author(s):
ZHAO Xiao-fei1;  WANG Xue-qian2;  ZHANG Pei-fang3
（1. Department of Clinical pharmacy, 2.Department of Respiratory and Critical Care Medicine, 3. Department of nursing, The Second Affiliated Hospital of Xingtai Medical College, Xingtai 054000, Hebei, China)
关键词:
哌拉西林钠/他唑巴坦钠; 头孢哌酮钠/舒巴坦钠; 医院获得性肺炎; 临床疗效; 成本分析; 肺表面活性蛋白A
Keywords:
piperacillin sodium/tazobactam sodium;  cefoperazone/sulbactam sodium;  hospital acquired pneumonia;  clinical efficacy;  cost analysis;  lung surfactant protein A
分类号:
R563.1
DOI:
10.3969/j.issn.1672-271X.2022.06.007
文献标志码:
A
摘要:
目的对比哌拉西林钠/他唑巴坦钠和头孢哌酮钠/舒巴坦钠两种给药方案在治疗医院获得性肺炎(HAP)患者中临床疗效和成本分析及其对肺表面活性蛋白A(SPA)水平的影响。方法选择2019年10月至2021年8月邢台医学高等专科学校第二附属医院收治的252例HAP患者，采用随机数字表法分成对照组和观察组，对照组患者给予头孢哌酮钠/舒巴坦钠治疗方案，观察组患者行哌拉西林钠/他唑巴坦钠治疗方案。比较、评估和分析2组患者临床疗效、细菌清除率、APACHEⅡ评分、炎性因子表达水平、肺功能、血清MP-IgM和SPA水平及不良反应等情况，通过成本-效果分析法对两种治疗方案进行药物经济学评价。结果治疗后，观察组的总有效率（94.44%）高于对照组（80.16%），差异无统计学意义（P=0.055）。治疗前观察组和对照组患者病原菌检出情况无差异；治疗后，2组患者均可有效清除病原菌，观察组总清除率为82.54%，对照组总清除率为78.57%，差异无统计学差异(P=0.426)。治疗后，2组患者APACHEⅡ评分明显降低，但差异无统计学意义(P=0.583)。2组患者降钙素原、C反应蛋白和白细胞计数明显降低，差异无统计学意义(P=0.636,0.860,0.796)。经过治疗，2组患者氧分压、FEV1和FEV1/FVC明显提高，二氧化碳分压明显降低，2组肺功能比较差异无统计学意义（P>0.05）。治疗后2组患者血清SPA水平明显降低，差异无统计学意义（P>0.05）。2组患者不良反应发生率无差异。观察组的成本-效果比高于观察组（30.52 vs 29.11），增量成本-效果分析显示观察组增量成本-效果比（ICER）为38.41元，远低于意愿支付阙值2607.94元，敏感性分析结果支持以上结果，说明观察组的治疗方案在药物经济学方面优于对照组。结论哌拉西林钠/他唑巴坦钠和头孢哌酮钠/舒巴坦钠均可有效改善临床疗效，清除病原菌，降低血清SPA水平，但哌拉西林阿他唑巴坦钠成本-效果优势高，是HAP临床治疗优选。
Abstract:
ObjectiveThis study aims to compare the clinical efficacy comparison and pharmacoeconomic evaluation of piperacillin sodium/tazobactam sodium and cefoperazone/sulbactam sodium in the treatment of hospital acquired pneumonia and its effect on serum SPA.MethodsA total of 252 HAP patients admitted to the Second Affiliated Hospital of Xingtai Medical College from October 2019 to August 2021 were randomly divided into control group and treatment group. The control group was given cefoperazone sodium and sulbactam sodium, and the treatment group was given piperacillin sodium and tazobactam sodium.The clinical efficacy, bacterial clearance rate, APACHEⅡ score, inflammatory factor expression level, lung function, SPA levels and adverse reactions of the two groups were compared, evaluated and analyzed. And pharmacoeconomic evaluation of the two treatment plans was conducted by cost-effectiveness analysis.ResultsAfter treatment, the total effective rate of the treatment group (94.44%) was higher than that of the control group (80.16%), and the difference was not statistically significant after Chi-square test (P=0.055).There was no difference in pathogen detection between the treatment group and the control group before treatment.The total clearance rate of the treatment group was 82.54%, while that of the control group was 78.57%, with no significant difference (P=0.426).After treatment, APACHEⅡ scores in 2 groups decreased significantly, but the difference was not statistically significant (P=0.583).Procalcitonin, C-reactive protein and white blood cell count were significantly decreased in 2 groups, with no statistical significance (P=0.636, 0.860, 0.796).After treatment, oxygen partial pressure, FEV1 and FEV1/FVC in 2 groups were significantly increased, while carbon dioxide partial pressure was significantly decreased, and there was no statistical significance in lung function between 2 groups (All P>0.05).After treatment, serum SPA level and 2 groups were significantly decreased, with no statistical significance（P>0.05）. There was no difference in the incidence of adverse reactions between the two groups. Cost-effectiveness analysis of the two groups showed that the cost-effectiveness ratio of the treatment group was higher than that of the treatment group (30.52 vs 29.11). Incremental cost-effectiveness analysis showed that ICER value of the study group was 38.41, far lower than the willingness to pay threshold of 2607.94. Sensitivity analysis supported the above results.It shows that the treatment plan of the treatment group was superior to the control group in pharmacoeconomics.ConclusionPiperacillin sodium, tazobactam sodium and cefoperazone sodium and sulbactam sodium can effectively improve the clinical efficacy, eliminate pathogenic bacteria, reduce serum SPA level positive expression, but piperacillin azobactam sodium has a high cost-effectiveness advantage, and is the preferred clinical treatment for HAP.

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备注/Memo

备注/Memo:
基金项目：邢台市科技计划项目（2019ZC222）
更新日期/Last Update: 2023-01-18