多黏菌素B对泛耐药鲍曼不动杆菌所致慢性阻塞性肺疾病呼吸机相关性肺炎的临床疗效  

The clinical effects of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant Acinetobacter baumannii in chronic obstructive pulmonary disease

作　　者：苗微微[1] 马良[1] 李波[1] 蒋力学[1] MIAO Weiwei MA Liang LI Bo JIANG Lixue(Department of Respiratory Medicine, The First Hospital of Harbin, Harbin, Heilony~iang 150010, P.R. China)

机构地区：[1]黑龙江省哈尔滨市第一医院呼吸内科,黑龙江哈尔滨150010

出　　处：《中国呼吸与危重监护杂志》2017年第4期332-336,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨多黏菌素B对泛耐药鲍曼不动杆菌所致慢性阻塞性肺疾病(简称慢阻肺)呼吸机相关性肺炎的临床疗效及安全性。方法回顾性分析2015年1月至2016年8月因泛耐药鲍曼不动杆菌所致慢阻肺呼吸机相关性肺炎而使用多黏菌素B治疗的11例患者资料,根据治疗前、治疗中、治疗后患者临床症状及实验室指标等变化评价患者使用多黏菌素B治疗的临床有效率、细菌清除率、病死率及安全性。结果 11例患者均由两所三甲医院的综合ICU转入我科,在我科给予单间隔离进行机械通气治疗。治疗时间为8~13 d,平均10 d。多黏菌素B治疗后大部分患者临床症状、体征、实验室检查及影像学检查较治疗前明显改善,其中7例患者临床治疗有效,有效率为63.6%(7/11);8例获得细菌学清除,细菌清除率为72.7%(8/11)。4例患者死亡,总体病死率为36.4%(4/11)。给予多黏菌素B治疗期间,只有1例出现药物热导致停药,药物不良反应发生率为9.1%(1/11)。结论多黏菌素B可尝试作为泛耐药鲍曼不动杆菌感染所致慢阻肺呼吸机相关性肺炎常规治疗方案失败后的治疗选择,但尚需要更可靠的临床证据。Objective To evaluate the clinical effects and safety of polymyxin B on ventilator-associated pneumonia caused by pandrug-resistant Acinetobacter baurnannii （PDR-AB） in patients with chronic obstructive pulmonary disease （COPD）. Methods COPD patients who were diagnosed as ventilator-associated pneumonia caused by PDR-AB and treated with polymyxin B between January 2015 and August 2016 in this hospital were included in this retrospective study. The patients＇ symptoms, vital signs, and the results of laboratory examinations were recorded before and after treatment. The clinical cure rates, microbiological eradication rates, mortality and safety were also measured. Results A total of 11 cases were included in this study. Mean time of therapy was 10 days, ranged 8-13 days. After treatment with polymyxin B, most of the patients＇ clinical symptoms, signs, and results of laboratory tests as well as imaging examinations were significantly improved. Seven cases had clinical response, and the clinical efficacy rate was 63.6%; 8 cases achieved bacteriological eradication, with the bacteriological eradication rate of 72.7%. Four patients died, and the overall mortality was 36.4%. Only 1 case discontinued treatment with polymyxin B because of the drug fever. Conclusions Polymyxin B might be an alternative option for COPD patients with ventilator-associated pneumonia caused by PDR-AB, who is non-responder to prior antimicrobial therapy. However, this method should be evaluated cautiously in prospective well-controlled studies.

关 键 词：多黏菌素B 鲍曼不动杆菌 泛耐药 慢性阻塞性肺疾病 呼吸机相关性肺炎 

分 类 号：R563.9[医药卫生—呼吸系统]