我院耐多药结核病治疗管理及药品不良反应发生情况分析

发布时间：2018-09-11 08:49

【摘要】：目的:为耐多药结核病(MDR-TB)患者合理使用抗结核药及减少药品不良反应(ADR)提供参考。方法:选取2012年2月-2015年5月我院结核病住院患者,按照疑似MDR-TB(202例)和确诊MDR-TB(162例)分为两组,进行药物组化疗法,并依据患者病情选择不同的治疗管理方式,并观察ADR发生情况。两组患者的治疗管理期均为18个月。结果:疑似MDR-TB组患者对一线药物的耐药率均≥26.24%,其中对异烟肼和利福平的耐药率为40%左右;对二线药物的耐药率均≥4.95%,其中对丙硫异烟胺耐药率最高,为46.04%;药敏试验结果显示,一线药物全敏感为44.06%,单耐药为14.36%,多耐药为9.90%,耐多药为31.68%;一、二线药物全敏感为21.78%,单耐药为24.75%,多耐药为17.82%,耐多药为32.67%,广泛耐药为2.97%。MDR-TB患者治疗管理方案中,结防机构治疗占56.17%;转诊于专科医院治疗占14.81%;未治疗者占22.22%;其他因素导致改变治疗方案或无法继续治疗占6.79%。确诊MDR-TB患者较疑似MDR-TB患者二线方案诊疗的ADR发生率较高,组间比较差异有统计学意义(P0.05)。经后期对症治疗均有所好转。结论:对于MDR-TB患者根据病情可有效寻找合适的治疗管理方案,提高疗效,降低ADR发生率,控制结核杆菌的传播与发展。
[Abstract]:Objective: to provide reference for the rational use of anti-tuberculosis drugs and the reduction of adverse drug reactions (ADR) in multi-drug resistant tuberculosis (MDR-TB) patients. Methods: the inpatients with tuberculosis in our hospital from February 2012 to May 2015 were divided into two groups according to suspected MDR-TB (202 cases) and confirmed MDR-TB (162 cases). The occurrence of ADR was observed. The treatment management period of both groups was 18 months. Results: the drug resistance rates of suspected MDR-TB group to first-line drugs were more than 26.24, in which isoniazid and rifampicin resistance rates were about 40%, and those to second-line drugs were more than 4.95, among which the highest drug resistance rate to propylthioisoniamin was 46.040.The results of drug sensitivity test showed that the drug resistance rate of all the patients in the suspected MDR-TB group was more than 26.24, and the resistance rate to isoniazid and rifampicin was about 40%. The total sensitivity of first-line drug was 44.06, single drug resistance was 14.366,multi-drug resistance was 9.90 and multidrug resistance was 31.68.The first, second-line drug sensitivity was 21.78, single drug resistance was 24.75cm, multi-drug resistance was 17.82, multi-drug resistance was 32.67, and extensive drug resistance was in the treatment management plan of 2.97%.MDR-TB patients. 56.17% of them were treated by preventive organization; 14.81% were treated by referral to specialized hospital; 22.2222% were treated without treatment; 6.79% were changed or unable to continue treatment due to other factors. The incidence of ADR in confirmed MDR-TB patients was higher than that in suspected MDR-TB patients, and the difference between groups was statistically significant (P0.05). The symptomatic treatment was improved at the later stage. Conclusion: according to the condition of MDR-TB patients, we can find suitable treatment management plan, improve the curative effect, reduce the incidence of ADR, and control the spread and development of Mycobacterium tuberculosis.
【作者单位】：宜昌市第三人民医院结核科;
【分类号】：R52

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