替加环素联合异帕米星治疗多重耐药鲍曼不动杆菌肺炎的临床观察

发布时间：2018-07-14 11:18

【摘要】：目的:观察替加环素联合异帕米星治疗多重耐药鲍曼不动杆菌肺炎的临床疗效及安全性。方法:选取被诊断为多重耐药鲍曼不动杆菌肺炎的患者70例,按随机数字表法分为对照组和观察组,各35例。两组患者均给予氧疗或机械通气、降压、控制血糖等常规治疗。对照组患者给予注射用头孢哌酮钠舒巴坦钠3 g加入氯化钠注射液100 ml中,ivgtt,qid;观察组患者给予注射用替加环素首次剂量100 mg,然后减至50 mg加入氯化钠注射液250 ml中,ivgtt,bid,联合硫酸异帕米星注射液400 mg加入氯化钠注射液250 ml中,ivgtt,qd。观察两组患者体温恢复正常、肺部Up音消失、胸片阴影消失、白细胞恢复正常时间及治疗前后血清炎性因子水平,并比较两组患者临床疗效、细菌学疗效及不良反应发生情况。结果:观察组患者体温恢复正常、肺部Up音消失、胸片阴影消失、白细胞恢复正常时间明显短于对照组,差异有统计学意义(P0.05)。治疗前,两组患者血清炎性因子水平比较,差异无统计学意义(P0.05);治疗后,两组患者血清炎性因子水平显著降低,且观察组明显低于对照组,差异均有统计学意义(P0.05)。观察组患者临床总有效率和有效细菌清除率(85.7%和82.9%)显著高于对照组(62.9%和60.0%),差异均有统计学意义(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。结论:替加环素联合异帕米星治疗多重耐药鲍曼不动杆菌肺炎疗效显著,能明显改善患者临床症状,控制炎症反应,杀菌作用明显,且安全性较高。
[Abstract]:Objective: to observe the efficacy and safety of tigicycline combined with isopamicin in the treatment of multiple drug resistant Acinetobacter baumannii pneumonia. Methods: seventy patients diagnosed as multidrug resistant Acinetobacter baumannii pneumonia were randomly divided into control group (n = 35) and observation group (n = 35). Both groups were given oxygen therapy or mechanical ventilation, hypotension, control of blood sugar and other routine treatment. The patients in the control group were given cefoperazone sodium sulbactam 3 g for injection and sodium chloride injection 100ml, and the patients in the observation group were given the first dose of tegacycline 100 mg for injection, then reduced to 50 mg and added to 250ml sodium chloride injection In combination with isopamicin sulfate 400 mg / ml sodium chloride injection 250ml iv gttt QD. The temperature of the two groups returned to normal, the pulmonary up sound disappeared, the shadow of chest film disappeared, the white blood cell returned to normal time and the level of serum inflammatory factors before and after treatment were observed. The clinical efficacy, bacteriological effect and adverse reaction were compared. Results: in the observation group, the temperature returned to normal, the pulmonary up sound disappeared, the chest film shadow disappeared, and the white blood cell returned to normal time was significantly shorter than that in the control group (P0.05). Before treatment, there was no significant difference in serum inflammatory factors between the two groups (P0.05); after treatment, the levels of serum inflammatory factors in the two groups decreased significantly, and the observation group was significantly lower than the control group, the difference was statistically significant (P0.05). The total clinical effective rate and effective bacterial clearance rate (85.7% and 82.9%) in the observation group were significantly higher than those in the control group (62.9% and 60.0%), and the difference was statistically significant (P0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P0.05). Conclusion: the efficacy of tegicycline combined with isopamicin in the treatment of Acinetobacter baumannii pneumonia with multiple drug resistance is significant. It can significantly improve the clinical symptoms, control inflammatory reaction, have obvious bactericidal effect, and have a high safety in the treatment of Acinetobacter baumannii pneumonia.
【作者单位】：开县人民医院呼吸内科;开县人民医院感染管理科;
【分类号】：R563.1

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