老年重症肺炎患者使用降阶梯方案治疗的效果观察  

Therapeutic effect of antimicrobial drug counter gradient mode on severe pneumonia in elderly patients

作　　者：杨晓燕[1] 梅劲超[1] 

机构地区：[1]广东省潮州市中心医院重症医学科,521000

出　　处：《河北医药》2015年第12期1769-1771,共3页Hebei Medical Journal

摘　　要：目的探讨老年重症肺炎患者采用抗菌药物降阶梯治疗法的临床疗效。方法选取2012年9月至2014年7月收治的120例老年重症肺炎患者,采用随机数字表法分为降阶组和对照组,每组60例,降阶组采用抗菌药物应用降阶梯治疗,对照组采用常规治疗,比较2组患者的住院指标及临床疗效差异。结果降阶组患者的啰音消失时间(11.5±2.2)d、咳嗽消退时间(12.8±2.5)d、感染控制时间(10.8±3.5)d、机械通气平均时间(4.8±2.4)d、入住ICU时间(7.8±3.0)d、住院总时间(13.8±4.5)d均显著的低于对照组(P<0.05),2组患者的病死率差异无统计学意义(P>0.05)。降阶组和对照组患者的Pa O2、Pa CO2、p H值、CRP、D-二聚体、前清蛋白测定值在治疗前差异均无统计学意义(P>0.05),治疗72 h后2组上述指标较治疗前均显著的好转(P<0.05),其中降阶组的CRP、D-二聚体治疗后显著优于对照组(P<0.05)。降阶组患者的治疗7 d后的总有效率93.33%高于对照组的83.33%,但差异无统计学意义(P>0.05),降阶组治疗7 d后的疗效分布(治愈、显效的比例高于对照,无效比例低于对照组)显著优于对照组(P<0.05)。结论老年重症肺炎患者采用抗菌药物降阶梯治疗法较常规治疗法能够显著的缩短患者临床症状缓解的时间、尽早的控制患者的感染症状,有利于进一步增强治疗效果。Objective To investigate the therapeutic effect of antimicrobial drug counter gradient mode on severe pneumonia in elderly patients. Methods One hundred and twenty senile patients with severe pneumonia admitted into our hospital from September 2012 to July 2014 were divided into counter gradient group（ n = 60） and control group（ n = 60）according to random digits table. The patients in counter gradient group were treated by antimicrobial drug counter gradient mode,however,the patients in control group were treated by routine therapy,and the clinical therapeutic effects and hospitalization parameters were observed and compared between two groups. Results The rale disappearance time [（ 11. 5 ±2. 2） d],cough subsided time [（ 12. 8 ± 2. 5） d],infection control time [（ 10. 8 ± 3. 5） d],the average time of mechanical ventilation [（ 4. 8 ± 2. 4） d],ICU length of stay [（ 7. 8 ± 3. 0） d],total hospitalization time [（ 13. 8 ± 4. 5） d] in counter gradient group were significantly lower than those in control group（ P 〈0. 05）,however,there was no significant difference in case fatality rate between two groups（ P 〉0. 05）. There were no significant differences in Pa O2,Pa CO2,p H value,CRP,D- dimer,prealbumin levels before treatment between two groups（ P 〉0. 05）,however,these parameters were obviously improved 72 h after treatment in both groups,as compared with those before treatment（ P 〈0. 05）,in which,CRP and D-dimmer in counter gradient group were superior to those in control group（ P 〈0. 05）. The total effective rate（ 93. 33%）in counter gradient mode was higher than that（ 83. 33%） in control group,but there was no significant difference between two groups（ P 〉0. 05）. The efficacy distribution in counter gradient group was superior to that of control group（ P 〈0. 05）.Conclusion The application of antimicrobial drug counter gradient mode in treatment of severe pneumonia in elderly patients can obviously shorten the catabatic time of clinic

关 键 词：重症肺炎 抗菌药物 降阶梯治疗 临床疗效 

分 类 号：R563.1[医药卫生—呼吸系统]