重症监护室耐碳青霉烯类鲍曼不动杆菌致医院获得性肺炎抗感染疗效评价  

Evaluation of Anti-Infection Treatment for Patients with Hospital Acquired Pneumonia in ICU Caused by Carbapenems-Resistant Acinetobacter Baumannii

作　　者：蒋俊杰 刘正东 王法财 常伟 沈炳香 聂松柳 Jiang Junjie;Liu Zhengdong;Wang Facai;Chang Wei;Shen Bingxiang;Nie Songliu(Lu＇an Hospital Affiliated to Medical University of Anhui,Lu＇an,Anhui,China 23700)

机构地区：[1]安徽医科大学附属六安医院,安徽六安237005

出　　处：《中国药业》2018年第22期82-85,共4页China Pharmaceuticals

摘　　要：目的探讨多种方案治疗重症监护室(ICU)耐碳青霉烯类鲍曼不动杆菌引起的医院获得性肺炎的临床疗效。方法回顾性分析2016年1月至2017年12月ICU中因耐碳青霉烯类鲍曼不动杆菌引起的重症医院获得性肺炎患者95例,按抗感染治疗方案的不同分为A组(29例)、B组(33例)和C组(33例),A组使用米诺环素联合头孢哌酮钠舒巴坦钠治疗,B组使用头孢哌酮钠舒巴坦钠联合阿米卡星治疗,C组单用头孢哌酮钠舒巴坦钠治疗,疗程均超过5 d。结果 A组总有效率为82. 76%,明显高于B组的63. 64%和C组的51. 52%(P=0. 035); 3组患者微生物清除率、药品不良反应发生率、ICU住院时间比较均无明显差异; 3组患者治疗后的主要炎症指标,包括白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)均显著降低(P <0. 05),且A组下降更明显(P <0. 05)。结论对于ICU耐碳青霉烯类鲍曼不动杆菌引起的重症医院获得性肺炎,以头孢哌酮钠舒巴坦钠为基础的联合用药方案较单用方案有更好的临床疗效,推荐米诺环素联合头孢哌酮钠舒巴坦钠方案。Objective To investigate the clinical efficacy of various regimens in the treatment of hospital acquired pneumonia（HAP） caused by carbapenems-resistant Acinetobacter baumannii. Methods The data of 95 patients with severe HAP caused by carbapen- ems- resistant Acinetobacter baumannii in ICU from January 2016 to December in 2017 were analyzed retrospectively. The patients were divided into group A（29 cases）,group B（33 cases） and group C（33 cases） according to the different anti-infective treatment regi- mens. Group A was treated with minocycline combined with cefoperazone sodium / sulbactam sodium,group B was treated with cefoperazone sodium / sulbactam sodium combined with amikacin,group C was treated with cefoperazone sodium / sulbactam sodium. All the courses of treatment were more than 5 d. Results The total effective rate of group A was 82.76% ,which was significantly higher than 63.64% of group B and 51.52% of group C（P =0. 035）. There was no statistical difference in microbial clearance rate,incidence rate of adverse drug reaction and hospitalization time in ICU among the three groups. The main inflammatory indexes of WBC,CRP and PCT in the three group were significantly decreased after treatment（P 〈 0.05）,and the decrease in group A was more significant（P 〈 0.05）. Conclusion Cefoperazone sodium / sulbactam sodium- based combination regimen has better clinical efficacy than single- use regiment in the treatment of HAP caused by carbapenemsresistant Acinetobacter baumannii in ICU,whereas minocycline combined with cefoperazone sodium / sulbactam sodium is a more effective clinical treatment regimen.

关 键 词：米诺环素 阿米卡星 头孢哌酮钠舒巴坦钠 鲍曼不动杆菌 重症监护室 医院获得性肺炎 临床疗效 

分 类 号：R969.3[医药卫生—药理学] R978.1[医药卫生—药学]