万古霉素封管治疗机械通气患者中心静脉导管葡萄球菌感染疗效观察  

Vancomycin-sealed tube method for treatment of Staphylococcus infection in mechanical ventilation patients with central venous catheter

作　　者：王伟华[1] 郑逸华[1] 徐利萍[1] 林雪梅[1] 林建青[1] 徐文芳[1] 徐林燕[1] 李振华[1] 

机构地区：[1]江山市人民医院呼吸内科,324100

出　　处：《浙江医学》2015年第22期1839-1842,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2011KYA166)

摘　　要：目的观察万古霉素封管治疗机械通气患者葡萄球菌导致的中心静脉导管相关血流感染(catheter-related bloodstream infection,CRBSI)的临床疗效。方法选择机械通气患者葡萄球菌导致的CRBSI患者,随机分为治疗组(31例)和对照组(32例)。治疗组采用万古霉素封管联合静脉滴注万古霉素治疗;对照组采用静脉滴注万古霉素治疗。观察两组患者的痊愈率、有效率、拔管率及安全性。结果葡萄球菌导致的CRBSI的临床疗效:治疗组痊愈率、有效率、拔管率分别为65.6%、75.0%、18.8%,对照组分别为38.7%、48.4%、38.7%,两组差别有统计学意义(均P<0.05);凝固酶阴性葡萄球菌(CNS)导致的CRBSI的临床疗效:治疗组痊愈率、有效率、拔管率分别是68.2%、77.3%、18.2%,对照组分别是40.0%、50.0%、35.0%,两组比较差别均有统计学意义(均P<0.05);金黄色葡萄球菌导致的CRBSI的临床疗效:治疗组痊愈率、有效率、拔管率分别是60.0%、70.0%、30.0%,对照组分别36.4%、45.5%、45.5%,两组比较差别均有统计学意义(均P<0.05)。结论万古霉素和肝素混合液封管,同时全身静脉使用万古霉素治疗机械通气患者葡萄球菌感染CRBSI,明显提高痊愈率、有效率,降低拔管率,并有良好的安全性。Objective To evaluate vancomycin-sealed tube method for treatment of catheter-related bloodstream infection （CRBSI） caused by Staphylococcus in mechanical ventilation patients with central venous catheter. Methods Sixty-three mechanical ventilation patients with CRBSI caused by Staphylococcus admitted in Jiangshan People＇s Hospital were divided into study group （n=31） and control group （n=32） randomly： patients in study group received intravenous infusion of vancomycin with vancomycin-sealed tube, and patients in control group received intravenous infusion of vancomycin only. The cure rate, effective rate, extubation rate and safety were compared between two groupsy. Results The cure rate, effective rate for CRBSI caused by Staphylococcus in study group were significantly higher than those in control group （65.6% vs 38.7% and 75.0% vs 48.4%, both P〈O.05）, and the extubation rate in study was lower than that in control group （18.8% vs 38.7%, P〈0.05）. The cure rate, effective rate for CRBSI caused by coagulase-negative Staphylococcus in study group were significantly higher than those in control group （68.2% vs 40.0%, 77.3% vs 50.0, both P〈0.05）, and the extubation rate in study was lower than that in control group （18.2% vs 35.0%, P〈0.05）. The cure rate, effective rate for CRBSI caused by Staphylococcus aureus in study group were also significantly higher than those in control group （60.0% vs 36.4% and 70.0% vs 45.5%, both P〈0.05）, and the extubation rate in study was lower than that in control group（30.0% vs 45.5%3, P〈0.05）. Conclusion The vacomicin-sealed tube method increases the cure rate, effective rate and reduces the extubation rate with high safety in treatment of staphylococcus CRBSI for mechanical ventilation patients.

关 键 词：中心静脉导管 导管相关性血流感染 机械通气 抗菌药物封管 万古霉素 

分 类 号：R515[医药卫生—内科学]