序贯疗法治疗老年肺部感染的临床疗效评价  

Clinical efficacy of antibiotic sequential therapy in the treatment of elderly patients with pulmonary infection

作　　者：张永靖[1] 袁艳娜 范金琳 ZHANG Yong-jing YUAN YAN-na FAN Jin-lin(Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan 450007, Chin)

机构地区：[1]郑州大学附属郑州市中心医院老年医学部普通内科,河南郑州450007

出　　处：《中华医院感染学杂志》2017年第4期792-795,共4页Chinese Journal of Nosocomiology

基　　金：河南省重点科技攻关基金资助项目(152102310184)

摘　　要：目的探讨抗菌药物序贯疗法治疗老年肺部感染的疗效及临床应用价值。方法选取2015年8月-2016年11月医院呼吸内科60例老年肺部感染患者为研究对象,随机分为序贯治疗组30例,持续静脉滴注组30例,两组分别采用不同的治疗方法,持续静脉注射组给予β-内酰胺类(包括第二、三代头孢菌素类、半合成青霉素、β-内酰胺类加酶抑制剂)、大环内脂类抗菌药物(包括红霉素、罗红霉素、阿奇霉素)、氟喹诺酮类(包括氧氟沙星、环丙沙星)滴注;序贯治疗组采用相同种类抗菌药物治疗,先静脉给药、待病情稳定后改为口服抗菌药物序贯治疗。结果序贯治疗组患者体温恢复正常、咳嗽咳痰减轻、肺部啰音减少的时间,分别为(3.62±0.65)d、(3.53±0.51)d、(3.87±0.73)d,显著低于持续静脉滴注组(4.28±0.69)d、(4.63±0.82)d、(4.73±0.87)d,差异有统计学意义(P<0.05);序贯治疗组患者细菌清除率和总有效率显著高于持续静脉滴注组患者,差异有统计学意义(P<0.05);序贯治疗组患者的药物不良反应率显著低于持续静脉滴注组患者,差异有统计学意义(P<0.05)。结论使用抗菌药物序贯疗法治疗老年肺部感染不仅可以取得较好的临床疗效,还可以有效降低药物不良反应,更安全可靠。OBJECTIVE To observe the clinical efficacy and application of antibiotic sequential therapy in the treatment of elderly patients with pulmonary infection.METHODS A total of 60 elderly patients with community acquired pneumonia（CAP）from Aug.2015 to Nov.2016 were selected as study objects,and were randomly divided into sequential therapy group（30cases）and continuous intravenous infusion group（30cases）.Patients in continuous intravenous infusion group were given beta-lactam classes（including the second and third generation cephalosporins,semisynthetic penicillins,and beta-lactam plus enzyme inhibitors）,macrolides antimicrobial agents（including erythromycin,roxithromycin,and azithromycin）,and fluoroquinolones（including ofloxacin and ciprofloxacin）.Patients in sequential treatment group were treated with the same type of antimicrobial agents,and given intravenous administration at first,then sequential theray with oral antimicrobial drugs when patiants in stable condition.RESULTS The defervescence time,cough reduction and pulmonary rale reduction in sequential therapy group were（3.62±0.65）d,（3.53±0.51）d,and（3.87±0.73）d,which were lower than（4.28±0.69）d,（4.63±0.82）d,and（4.73±0.87）d in continuous intravenous infusion group,and the difference was statistically significant（P〈0.05）.The bacterial clearance rate and total effective rate of sequential therapy group were significantly higher than those of continuous intravenous infusion group,and the difference was statistically significant（P〈0.05）.In addition,the adverse drug reaction rate of sequential therapy group was significantly lower than that of continuous intravenous drip group,and the difference was statistically significant（P〈0.05）.CONCLUSION In the term of senile pulmonary infection,antibiotic sequential therapy can not only obtain a better clinical outcome,but also effectively reduce the adverse drug reactions,which is safer and more reliable.

关 键 词：肺部感染 Β-内酰胺类 大环内脂类 氟喹诺酮类 序贯疗法 

分 类 号：R563.1[医药卫生—呼吸系统]