替加环素治疗医院获得性肺炎的临床疗效分析和循证药学

发布时间：2018-04-21 19:38

本文选题：替加环素 + 医院获得性肺炎　；参考：《重庆医科大学》2017年硕士论文

【摘要】：目的分析在医院获得性肺炎(hospital-acquired pneumonia,HAP)患者中运用替加环素(Tigecycline,TGC)治疗的效果,为TGC的合理使用提供参考。方法回顾性分析我院2014年1月-2016年12月诊断为HAP的患者,并应用TGC抗感染治疗,评估其临床疗效和细菌学疗效。运用SPSS.18进行统计分析。结果24例患者符合入选标准,平均年龄69.3±11.81岁,平均住院时间31.7±9.1天,TGC疗程平均11.7±3.5天,患者APACHE II评分平均20.0±5.0分。在收集到的24例患者中,培养出鲍曼不动杆菌有23例,其中,对氟喹诺酮类环丙沙星、左氧氟沙星耐药率分别为100%、91.30%,碳氢霉烯类亚胺培南、美罗培南100%耐药,氨基糖苷类阿米卡星100%耐药,加酶抑制剂的氨苄西林/舒巴坦、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦耐药率分别为100%、90.91%、82.61%、四环素类米诺环素、替加环素耐药率分别为39.13%、0。24例患者的治疗方案,均是以TGC为基础的联合。联合使用最多的抗菌药是碳氢霉烯类和头孢哌酮舒巴坦,分别占22.5%、20%。24例患者,临床有效率46.25%(n=11),细菌清除率25%(n=6),死亡率37.5%(n=9)。结论TGC可用于治疗HAP,联合应用效果可能更佳。目的运用Meta分析方法评价替加环素(Tigecycline,TGC)治疗医院获得性肺炎(hospital-acquired pneumonia,HAP)的临床疗效、细菌学疗效及不良反应。方法计算机检索Pub Med、Medline、EBSCOhost、中国知网、维普、万方等数据库有关TGC治疗HAP的对照研究,采用Rev Man5.0软件进行Meta分析。结果最终纳入15篇文献,8篇RCT和7篇回顾性研究,合并分析提示TGC治疗HAP时,临床有效率优于non-TGC组(OR=2.02,95%CI[1.36,3.00],P0.05),细菌清除率方面优于non-TGC组(OR=1.68,95%CI[1.26,2.25],P0.05),总体死亡率方面优于non-TGC组(OR=0.55,95%CI[0.37,0.83],P0.05)住ICU时间也优于non-TGC组(SMD=-2.51,95%CI[-2.72,-2.29],P0.05),但不良反应、总住院时间两组比较没统计学差异。亚组分析表明治疗VAP时,其有效率、细菌清除率并不优于non-TGC组;单药治疗HAP时,并不优于non-TGC组。结论TGC可用于治疗HAP,联合应用效果更佳,但仍需要更多高质量的RCT来证实。
[Abstract]:Objective to analyze the therapeutic effect of tigecycline in hospital acquired pneumonia (HAP) patients, and to provide a reference for the rational use of TGC. Methods the patients with HAP diagnosed in our hospital from January 2014 to December 2016 were analyzed retrospectively. The clinical and bacteriological effects were evaluated by TGC antiinfective therapy. SPSS.18 was used for statistical analysis. Results the mean age was 69.3 卤11.81 years old, the average hospitalization time was 31.7 卤9.1 days and the average APACHE II score was 20.0 卤5.0 days. Among the 24 patients, 23 were isolated from Acinetobacter baumannii. Among them, the resistance rates to fluoroquinolone ciprofloxacin and levofloxacin were 100%, 91.30%, 100%, 100%, respectively. Ampicillin / sulbactam, piperacillin / tazobactam and cefoperazone / sulbactam were 100% resistant to aminoglycoside amikacin, respectively. The drug resistance rates of tegacycline were 39.13 and 0.24 cases respectively, all of which were based on TGC. The most commonly used antimicrobial agents were hydrocarbon and cefoperazone sulbactam, accounting for 22.5% and 20.24 cases, respectively. The clinical effective rate was 46.25%. The bacterial clearance rate was 25% and the mortality rate was 37.5%. Conclusion TGC can be used in the treatment of HAP, and the combined application may be more effective. Objective to evaluate the clinical efficacy, bacteriological efficacy and adverse reactions of tigecycline (TGCs) in the treatment of hospital acquired pneumonia (HAP) by Meta analysis. Methods Pub Medline was searched by computer for the comparative study of TGC treatment HAP in the databases of Pub Medline Medline, China knowledge Network, Weip, Wanfang and so on. The Meta analysis was carried out with Rev Man5.0 software. Results the 15 literatures, including 8 RCT and 7 retrospective studies, were included in the study. The combined analysis suggested that TGC was used in the treatment of HAP. The subgroup analysis showed that the effective rate and bacterial clearance rate of VAP were not better than those of non-TGC group, and that of single drug treatment of HAP group was not better than that of non-TGC group. Conclusion TGC can be used in the treatment of HAP, but more high quality RCT is needed.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R563.1

【参考文献】