预防性抗菌治疗对急性缺血性卒中并发感染的效果观察  

Effect of preventive antibacterial therapy on infection rates of acute ischemic stroke

作　　者：方国栋 张丽华[2] 

机构地区：[1]中南大学职工医院药剂科,湖南长沙410083 [2]中南大学湘雅医院卫生部纳米生物技术重点实验室,湖南长沙410087

出　　处：《中国医学工程》2017年第8期16-20,共5页China Medical Engineering

摘　　要：目的探讨抗菌剂莫西沙星预防性治疗对急性卒中患者感染的影响。方法将79例严重、非腔隙性及大脑中动脉区域缺血性卒中患者纳入本次研究。患者在卒中发生后36 h内接受莫西沙星(每日400 mg)静脉注射或者安慰剂治疗。临床研究主要终点是卒中后11 d发生感染。次要终点包括神经系统结局、生存率及卒中导致的免疫系统抑制等。结果卒中发生11 d内莫西沙星治疗组感染率为12.8%,安慰剂组为35.0%,比较差异有统计学意义(P<0.05)。卒中感染率与较低存活率有关。莫西沙星治疗没有明显改善神经功能预后和患者生存率。Logistic回归分析表明治疗方式以及治疗方式和单核细胞人类白细胞抗原DR(HLA-DR)表达之间的相互关系能独立预测卒中后感染。结论预防性抗生素莫西沙星治疗抑制了大脑中动脉(MCA)区域严重缺血性中风患者感染率,卒中感染患者6个月随访期间内生存率显著降低。【Objective】To investigate the effect of preventive antibacterial therapy with moxifloxacin on infection rates of acute ischemic stroke.【Methods】Preventive antibacterial therapy in acute ischemic stroke is a randomized,double-blind,placebocontrolled trial in 79 patients with severe,non-lacunar,ischemic stroke in the middle cerebral artery（MCA） territory.Patients received either intravenous moxifloxacin（400 mg daily） or placebo for 5 days starting within 36 hours after stroke onset.Primary endpoint was infection within 11 days.Secondary endpoints included neurological outcome,survival and development of strokeinduced immunodepression.【Results】On intention-to-treat analysis（79 patients）,the infection rate at day 11 in the moxifloxacin treated group was 12.8% compared to 35.0% in the placebo treated group（P〈0.05）.Stroke associated infections were associated with a lower survival rate.In this study,neurological outcome and survival rate were not significantly influenced by treatment with moxifloxacin.On logistic regression analysis,treatment arm as well as the interaction between treatment arm and monocytic human leucocyte antigen-DR（HLA-DR） expression（a marker for immunodepression） at day 1 after stroke onset was independently and highly predictive for post-stroke infections.【Conclusion】Preventive antibiotic therapy with moxifloxacin reduces the infection rate in patients with severe ischemic stroke in the MCA territory.A significant lower survival rate is found during 6 month follow-up for patients with infections.

关 键 词：卒中 感染 莫西沙星 

分 类 号：R456.2[医药卫生—治疗学]