替加环素治疗呼吸机相关性肺炎老年危重症患者的疗效观察  

Observation of the clinical efficacy of tigecycline for treatment of ventilator-associated pneumonia in critically ill elderly patients

作　　者：吕晓春[1] 蔡国龙[1] 许强宏[1] 

机构地区：[1]浙江医院重症医学科,杭州310013

出　　处：《中华医学杂志》2016年第7期535-538,共4页National Medical Journal of China

基　　金：浙江省重点科技创新团队自主设计项目（2011R50018-13）;浙江省中医药重点研究项目（2011ZZ001）;浙江省医药卫生科技计划研究项目（2013KYB004）;省重点科技创新团队研究项目（2011R50018-02）

摘　　要：目的评价替加环素治疗呼吸机相关性肺炎（VAP）老年危重症患者的临床疗效。方法回顾性分析2011年6月至2014年3月浙江医院重症医学科应用替加环素治疗VAP老年危重症患者的病例资料，对其临床疗效进行评价。结果纳入79例患者（男83．5％），平均年龄84（65～100）岁。感染常见的致病菌为鲍曼不动杆菌（39．1％）、铜绿假单胞菌（35．0％）和肺炎克雷伯菌（23．8％）。所有患者均接受替加环素治疗，其中54．4％的患者联合其他抗菌药物，35．4％为加倍剂量应用，抗生素应用的平均时间为9（2—22）d。治疗结束后，临床成功44例（55．7％），临床失败29例（36．7％），临床不确定6例（7．6％）。治疗结束28d后，患者总体病死率为39．0％。亚组分析表明，临床成功率与APACHEII评分是否〈15相关（APACHEII〈15与APACHEⅡ≥15的临床成功率分别为72．2％和41．9％，P=0．007），同时比较差异有统计学意义的包括替加环素是否使用加倍剂量（71．4％比47．1％，P=0．037），以及是否联合应用其他抗菌药物（67．4％比41．7％，P=0．022）。结论替加环素治疗VAP的老年危重症患者联合用药或使用加倍剂量均可改善临床疗效。Objective To evaluate the efficacy of tigecycline for treatment of ventilator-associated pneumonia in critically ill elderly patients. Methods Data of critically ill elderly patients with ventilator-associated pneumonia treated with tigecyeline in the intensive care unit was collected from June 2011 to March 2014 in this retrospective study, to evaluated the clinical efficacy of tigecycline. Results A total of 79 patients （83.5% male） were included, the mean age was 84 years old （rang, 65 years to 100 years old）. Aeinetobaeter baumannii （ 39. 1% ）, Pseudomonas aeruginosa （ 35.0% ） and Klebsiella pneumonia （23.8%） were the most common pathogens. All patients were treated with tigecyeline, 54.4% combined with other antimierobial agents, 35.4% treated with double dose of tigeeycline, and the mean course of antibiotic treatment was 9 days （range, 2 days to 22 days）. After treatment, clinical success were recorded in 44 patients （55.7%） , clinical failure were recorded in 29 patients, clinical uncertainty were recorded in 6 patients. 28 days after treatment, patients＇ overall mortality was 39.0%. The clinical success rates were associated with acute physiology and chronic health evaluation （APACHE） Ⅱ score less than 15 （the clinical success rates were 72. 2% and 41.9% in patients with APACHE Ⅱ score 〈 15 and APACHE Ⅱ score≥15, respectively; P = 0. 007）; treated with double dose of tigecyeline （71.4% vs 47.1%, P = 0. 037） or combination regimens were also had significant difference （67.4% vs 41.7% , P =0. 022）. Condusions Treatment of tigeeycline combined with other antimicrobial agents and double dose of tigeeycline may both can improve clinical efficacy in critically ill elderly patients with ventilator-associated pneumonia.

关 键 词：肺炎 通气机 负压 替加环素 

分 类 号：R563.1[医药卫生—呼吸系统]