雾化吸入阿米卡星治疗呼吸机相关性肺炎的临床疗效评价

发布时间：2018-02-20 00:00

本文关键词： 呼吸机相关性肺炎雾化吸入阿米卡星　出处：《蚌埠医学院》2013年硕士论文　论文类型：学位论文

【摘要】：目的评价雾化吸入阿米卡星治疗多重耐药（MDR）革兰阴性菌感染导致的呼吸机相关性肺炎（VAP）的临床疗效。方法以我院重症加强治疗病房（ICU）VAP患者为研究对象，将2011年11月-2013年02月收集的109例VAP患者的下呼吸道痰培养结果和药敏试验进行对比分析。根据纳入和排除标准，将符合标准的56名VAP患者随机分为实验组(29例)对照组(27例)。两组均给予全身抗感染治疗，实验组同时给予阿米卡星雾化吸入治疗。比较两组临床肺部感染评分（CPIS）、治愈率和病原菌清除率，同时观察患者耐受情况、肝肾功能和细菌耐药等情况。结果1、在109例VAP患者中下呼吸道共培养出127株不同的病原菌，革兰氏阴性菌、革兰氏阳性菌、真菌分别占病原菌总数的77.95%、13.39%、8.66%。排在前三位的分别是铜绿假单胞菌（16.54%）、鲍曼不动杆菌（11.81%）、肺炎克雷伯菌（8.66%）。药敏分析显示绝大多数革兰氏阴性菌为MDR菌。 2、实验组与对照组比较，在治疗疗程、治疗第1-5天CPIS无统计学意义（P＞0.05）；在治疗第10-14天后，CPIS有统计学意义（P＜0.05）；治愈率分别为68.97%和40.74%，，有统计学意义（P＜0.05）；病原菌清除率分别为72.41%和55.56%，无统计学意义（P＞0.05）。CPIS与患者的治愈率、病原菌清除率显示出明显的相关性。实验组没有因为雾化吸入导致严重不良反应发生。结论1、雾化吸入阿米卡星能够降低VAP患者的CPIS及提高治愈率，而无明显不良反应。 2、雾化吸入阿米卡星在VAP患者的病原菌清除率上具有一定优势。
[Abstract]:Objective to evaluate the efficacy of atomization inhalation of amikacin in the treatment of ventilator associated pneumonia (VAP) caused by multidrug resistant MDR gram-negative bacteria infection. Methods the results of lower respiratory tract sputum culture and drug sensitivity test in 109 VAP patients collected from November 2011 to February 2013 were compared and analyzed according to the criteria of inclusion and exclusion. 56 patients with VAP were randomly divided into experimental group (n = 29), control group (n = 27) and control group (n = 27). The experimental group was treated with amikacin atomization inhalation at the same time. The clinical pulmonary infection score (CPIS), cure rate and pathogen clearance rate were compared between the two groups, and the patient's tolerance, liver and kidney function and bacterial drug resistance were observed at the same time. Results 1. In 109 patients with VAP, 127 strains of different pathogens were cultured in the lower respiratory tract, including Gram-negative bacteria, Gram-positive bacteria, and Gram-positive bacteria. Fungi accounted for 13.398.66. the first three were Pseudomonas aeruginosa 16.54g, Acinetobacter baumannii 11.81, Klebsiella pneumoniae 8.660.Drug sensitivity analysis showed that most gram-negative bacteria were MDR. 2.Compared with the control group, the treatment course of the experimental group, There was no significant difference (P > 0.05) in CPIS between 1-5 days and 10-14 days after treatment, the cure rates were 68.97% and 40.74, respectively (P < 0.05), and the pathogen clearance rates were 72.41% and 55.56, respectively (P > 0.05). There was no serious adverse reaction caused by atomization inhalation in the experimental group. Conclusion 1. Atomization inhalation of amikacin can reduce CPIS and improve cure rate of VAP patients without obvious adverse reaction. 2. Aerosol inhalation of amikacin has some advantages in the clearance rate of pathogens in patients with VAP.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R563.1

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