替加环素治疗重症患者呼吸机相关性肺炎  

Tigecycline in treating ventilator-associated pneumonia in critically ill patients

作　　者：孟伟[1] 吴大玮[1] 单悌超[1] 张帆[1] 郭海鹏[1] 刘宇[1,2] 丁士芳[1] 翟茜[1] 

机构地区：[1]山东大学齐鲁医院重症医学科,山东济南250012 [2]山东大学齐鲁医院感染管理处,山东济南250012

出　　处：《山东大学学报（医学版）》2017年第4期71-75,共5页Journal of Shandong University:Health Sciences

基　　金：卫生部国家临床重点专科建设项目(2011-873);中华医学会临床医学科研专项(1103016060)

摘　　要：目的评价替加环素治疗重症患者呼吸机相关性肺炎(VAP)的临床疗效与安全性。方法选取2011年1月1日至2013年5月31日山东大学齐鲁医院重症监护病房的VAP患者33例,给予替加环素治疗,初始剂量100 mg,维持剂量50 mg,静脉滴注,每隔12 h注射1次,根据患者具体病情确定给药疗程。评价患者的临床成功率、细菌清除率及安全性。结果入组病例37例,最终可评价病例33例,临床成功率61%(20/33)。共分离得到36株多重耐药菌,均对替加环素敏感,总清除率61%(22/36),其中分离率最高的鲍曼不动杆菌清除率60%(18/30)。不良反应以消化道症状为主,经临床对症治疗后好转。6例于治疗28 d内死亡。结论替加环素治疗危重患者VAP疗效确切,耐受性良好。Objective To evaluate the clinical efficacy and safety of tigecycline in critically ill patients with ventilator- associated pneumonia （VAP）. Methods A prospective study was conducted based on critically ill patients with VAP in Intensive Care Unit of Qilu Hospital of Shandong University during Jan 1, 2011 and May 31, 2013. All patients ac- cepted intravenous infusion of tigecycline with a first dose of 100 mg and then 50 mg every 12 h. The course was direct- ed by medical advice. The clinical and bacterial efficacy and safety were evaluated at the end of the therapy. Results A total of 37 patients were included at the beginning, and 33 patients were evaluable at the endpoint. The total clinical success rates was 60.6%. Thirty-six multidrug-resistance bacteria strains were detected in specimens obtained from all patients before the start of tigecycline treatment, and all these strains were sensitive to tigecycline. The total clearance rate was 61% while Acinetobacter baumannii predominated a 60% clearance rate. Adverse reactions were well tolerated with predominantly digestive symptoms, and all responded to symptomatic treatment afterwards. Six patients died within 28 days. Conclusion Tigecycline proved to be effective and safe for critically ill patients with VAP.

关 键 词：替加环素 危重症 呼吸机相关性肺炎 多重耐药 鲍曼不动杆菌 

分 类 号：R563.1[医药卫生—呼吸系统]