雾化吸入阿米卡星治疗铜绿假单胞菌引起的呼吸机相关性肺炎的临床观察  

Clinical efficacy of nebulized amikacin in the treatment of ventilator-associated pneumonia caused by Pseudomonas aeruginosa

作　　者：李虎[1] 杨春辉[1] 薛杨勇[1] 徐丹[1] 崔宇慧[1] 唐建国[1] LI Hu YANG Chun-hui XUE Yang-yong XU Dan CUI Yu-hui TANG Jian-guo(Shanghai Fifth People＇s Hospital, Fudan University, Shanghai 200240, Chin)

机构地区：[1]复旦大学附属上海市第五人民医院,上海200240

出　　处：《内科急危重症杂志》2016年第5期335-337,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的:评价雾化吸入阿米卡星治疗铜绿假单胞菌引起的呼吸机相关性肺炎(VAP)的临床疗效和安全性。方法:铜绿假单胞菌引起的VAP患者76例,随机分为雾化治疗组(雾化组38例)和常规治疗组(对照组38例),比较雾化治疗结束后2组患者临床治愈率、细菌学反应、病死率、机械通气时间、住ICU时间及不良反应。结果:雾化组患者7 d临床治愈率显著高于对照组(76.3%vs 52.6%,P<0.05)。以敏感菌株进行分层,雾化组患者的7 d和28 d临床治愈率均高于对照组(P<0.05)。雾化组患者细菌载量在治疗过程中迅速降低,对照组患者细菌载量在治疗前3 d内有明显降低,但后期未见明显下降。2组患者的病死率、平均机械通气时间、平均住院时间、平均住重症监护病房时间及不良反应未见明显差异。结论:雾化吸入阿米卡星是一种安全的治疗方法,用于治疗铜绿假单胞菌,尤其是对阿米卡星敏感的铜绿假单胞菌引起的VAP,有助于提高患者临床治愈率和细菌清除率,但对患者病死率、住ICU时间、机械通气时间无明显影响。Objective To evaluate the effectiveness and safety of nebulized amikacin in the treatment of ventilator-asso- ciated pneumonia （VAP） caused by Pseudomonas aeruginosa. Methods ： An open-label randomized controlled no-blind trial was conducted. From January 2011 to December 2014, a total of 76 VAP patients caused by Pseudomonas aeruginosa were randomly divided into control group （38 cases） and nebulized group （38 cases ）. The rate of clinical cure, bacterial re- sponse, mortality, duration of mechanical ventilation, length of hospital stay and adverse events were compared. Results ： The rate of 7-day clinical cure in nebulized group was significantly higher than that in control group （76.3% vs 52.6%, P 〈 0.05）. When only including the patients in whom VAP was caused by Pseudomonas aeruginosa sensitive to amikacin, the rate of 7-day and 28-day clinical cure in nebulized group was both significantly higher than that in control group （ P 〈 0.05）. Patients in nebulized group had rapid reduction of bacterial growth. Bacterial growth in control group was reduced rapidly in preceding 3 days, but didn t decline obviously in the following days. There were no significant differences be- tween two groups in mortality, duration of mechanical ventilation, the length of ICU stay and hospital stay and adverse e- vents. Conclusion ： Nebulized amikacin is a safe therapy in the treatment of VAP caused by Pseudomonas aeruginosa, espe- cially that is sensitive to amikacin, which could increase the rate of clinical cure and reduce bacterial growth, but did not decrease patients＂ mortality, length of hospital stay and duration of mechanical ventilation.

关 键 词：呼吸机相关性肺炎 雾化疗法 机械通气 铜绿假单胞菌 

分 类 号：R563.1[医药卫生—呼吸系统]