抗生素单剂与联合治疗社区获得性肺炎的临床疗效观察  

Clinical Efficacy of Single Versus Combination Antibiotic Therapy in Community Acquired Pneumonia

作　　者：强丽霞[1] 藏伟佳 李香顺[1] 赵婷婷[1] 吕娜[1] 金寿德[1] 王凤爽[3] 

机构地区：[1]哈尔滨医科大学附属第四医院呼吸内科,黑龙江哈尔滨150001 [2]哈尔滨市南岗区人民医院感染科,黑龙江哈尔滨150000 [3]哈尔滨医科大学附属第四医院静配中心,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2015年第24期4672-4676,共5页Progress in Modern Biomedicine

基　　金：黑龙江省留学归国基金项目(LC201024)

摘　　要：目的：观察β内酰胺类联合大环内酯类与β内酰胺类单剂治疗社区获得性肺炎的临床疗效。方法：收集我院呼吸内科住院的社区获得性肺炎患者262例,随机分为单剂治疗组和联合治疗组。两组患者均给予抗感染、对症支持治疗,其中单剂治疗组抗生素采用β内酰胺酶类单剂治疗,联合治疗组采用β内酰胺酶类和大环内酯类联合治疗。所有患者统计年龄、性别、基础疾病、病情严重程度,并记录治疗前与治疗后不同住院天数的血常规、C反应蛋白的变化,统计住院天数。结果：联合治疗患者一般基本情况（年龄、性别、基础疾病、病情严重程度）与单剂治疗组相比,P〉0.05,差异均无统计学意义。治疗前及治疗后首日C反应蛋白和白细胞计数二者相比,P〉0.05,差异均无统计学意义;联合治疗组与单剂治疗组相比,C反应蛋白在住院第2、4、6、9天,白细胞计数在住院第2、4、6天,均明显下降,住院天数缩短,P〈0.05,差异均有统计学意义。对于中、重度CAP（CRB65≥2）,联合治疗组与单剂治疗组相比,治疗后C反应蛋白以及白细胞计数明显减少,P均〈0.05,差异有统计学意义;对于轻度CAP（CRB65=0~1）,两组治疗后CRB和白细胞计数相比,P均〉0.05,差异无统计学意义。结论：β内酰胺类联合大环内酯类治疗治疗社区获得性肺炎临床疗效优于β内酰胺类单剂治疗。Objective： To investigate the clinical efficacy of β-lactam/macrolide versus β-lactam monotherapy in community-acquired pneumonia. Methods： 262 community-dwelling patients with pneumonia who hospitalized were observed. All patients receiving antibiotics and supportive treatment were randomly divided into single therapy group with β-lactamases and combination therapy group withβ-lactamases and macrolides. All patients were assessed at the presentation. In all cases, the age, sex, complication, illness severity and hospital day of the patients were recorded. White blood cell count and C-reactive protein before and after treatment was detected, and the days of hospitalization were recorded. Results： Basic information including age, sex, underlying disease, severity of illness, and C-reactive protein and white blood cell counts before treatment and the first day after treatment were not significantly different（P〉0.05） between the single-dose treatment group and combination therapy. C-reactive protein in the hospital 2, 4, 6, 9 days, the white blood cell count in 2,4,6 days in hospital, were significantly decreased and the days of hospitalization were shortened, and the difference was statistically significant（P〈0.05）. What’s more, for the moderate and severe CAP（CRB65≥2）, there was statistical significance in C-reactive protein and white blood cell count after treatment between two groups（P〈0.05）. However, for the mild CAP（CRB65=0~1）, the difference of C-reactive protein and white blood cell counts between the two groups after treatment was not statistically significant（P〉0.05）. Conclusions： Combination therapy of β-lactam and macrolide might be more effective than β-lactam single-agent therapy for elderly community acquired pneumonia.

关 键 词：Β内酰胺类 大环内酯类 社区获得性肺炎 经验性治疗 

分 类 号：R563[医药卫生—呼吸系统]