降阶梯治疗重症获得性下呼吸道感染的临床应用  

De-escalation therapy of severe lower airway infection and its clinical use in ICU

作　　者：张宝民[1] 孙艳[1] 徐继来[1] 潘利平[1] 

机构地区：[1]连云港市第一人民医院东方医院ICU,222042

出　　处：《安徽医学》2009年第2期162-164,共3页Anhui Medical Journal

摘　　要：目的使用降阶梯方案治疗重症监护病房(ICU)重症获得性下呼吸道感染,评价其疗效。方法选取2005年1月1日-2007年12月31日,我院ICU重症获得性下呼吸道感染患者46例,随机分为传统治疗组和降阶梯治疗组,传统治疗组以头孢哌酮/舒巴坦+阿米卡星、哌拉西林/他唑巴坦+左氧氟沙星为经验性治疗方案;降阶梯治疗组以亚胺培南/西司他丁+去甲万古霉素作为经验性治疗方案,比较两组患者的初始治疗恰当率、感染控制率和感染控制所需时间等指标。结果降阶梯治疗组和传统治疗组的初始治疗恰当率为73.91%vs52.17%,P<0.01,治疗有效率82.61%vs47.83%,P<0.05,感染控制所需的天数为7.3±2.8vs13.4±4.3,P<0.05。结论对于ICU重症获得性下呼吸道感染使用降阶梯治疗可获得较好疗效。且亚按培南/西司他丁+去甲万古霉素作为重症获得性下呼吸道感染起始经验性用药,可防止病情迅速恶化,随后根据病原学及临床效果换用针对性抗菌药物的降阶梯疗法有其合理性。Objective To use de-escalation therapy for the severe lower airway infection in the ICU,and estimate the curative effect. Methods Selected 46 patients of severe lower airway infection from Janurary 1st 2005 to December 31st 2007,randomly divided into two groups,traditional group and de-escalation group.In traditional group Cefoperazone Sodium with Sulbactam ＋ Amikaein and Piperaeillin Sodium with Tazobactam ＋ levofloxacin were given as empirically therapy, while in de-escalation group Imipenem with Cilastatin ＋ Norvancomycin were specially given as empirically therapy. To compare their adequate rate of initial therapy,infection controlled rate and the days from the treatment beginning to the infection controlled. Results Between de-escalation group and traditional group,the adequate rate of initial therapy was 73.91% vs 52.17%,respectively,P〈0.01. The infection controlled rate was 82.61% vs 47.83% ,respectively,P〈0.05. The days from the treatment beginning to the infection controlled was 7.3±2.8 vs 13.4±4.3,respectively,P〈0.05. In de-escalation group, the clinical effect of Imipenem with Cilastatin was actually the best. Conclusions Using de-escalation therapy in ICU for severe lower airway infection would have better curative effect. Imipenem with Cilastatin could be of first choice to prevent disease worse and then it＇s reasonable to change the antibiotic by bacterial vaginosis and clinical effect.

关 键 词：降阶梯治疗 ICU 重症获得性下呼吸道感染 

分 类 号：R56[医药卫生—呼吸系统]