国产亚胺培南/西司他汀治疗236例血液病化疗相关粒细胞缺乏并发热患者的有效性和安全性分析  

Efficacy and safety of domestic imipenem-cilastatin in the treatment of 236 hemopathy patients with chemotherapy-associated agranulocytosis and fever

作　　者：郑润辉[1] 覃鹏飞[1] 罗晓丹[1] 王春燕[1] 刘丹[1] 李海明[1] 郜靓 林竞韧[1] 黄振倩[1] 谭获[1] Zheng Runhui;Qin Pengfei;Luo Xiaodan;Wang Chunyan;Liu Dan;Li Haiming;Gao Liang;Lin Jingreng;Huang Zhenqian;Tan Huo(Department of Hematology,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510230,China)

机构地区：[1]广州医科大学附属第一医院血液内科,510230

出　　处：《国际医药卫生导报》2019年第22期3725-3729,共5页International Medicine and Health Guidance News

摘　　要：目的观察分析国产亚胺培南/西司他汀治疗恶性血液病化疗导致粒细胞缺乏并发热的有效性和安全性。方法选择2015年7月至2018年7月在本院血液科接受诊治的粒细胞缺乏并发热的恶性血液病患者共236例,采用回顾性分析方法对所有恶性血液病患者化疗后合并粒细胞缺乏并发热的临床特点及一线应用国产亚胺培南/西司他汀治疗的临床疗效及安全性进行分析。结果粒细胞缺乏感染部位为肺部居多,肺部感染有81例(34.3%),血流感染有37例(15.7%),口腔感染有29例(12.3%)。通过病原学检查共培养出104株病原体,其中最多的是肺炎克雷伯菌(17株)、大肠埃希菌(15株)、铜绿假单胞菌(15株)和嗜麦芽假丝单胞菌(14株);而在61株G-杆菌中(不包括14株嗜麦芽假丝单胞菌),体外药敏实验提示亚胺培南/西司他汀敏感率为67.2%(41/61),其中39株发酵菌亚胺培南敏感率为94.9%,22株非发酵菌亚胺培南敏感率为50%。粒细胞缺乏患者一线选择国产亚胺培南/西司他汀单药24 h退热率为28%,联合用药退热率为52.5%,总有效率为80.5%,其中感染性休克抢救成功率为90.9%。国产亚胺培南/西司他汀安全性高,主要副作用为胃肠道反应,表现为恶心、胃纳下降,占11.9%,肾毒性,肌酐升高占11%,药物性肝损5%,精神改变1.3%,停药后均可恢复。结论国产亚胺培南/西司他汀一线治疗粒细胞缺乏并发热安全有效。Objective To observe and analyze the efficacy and safety of domestic imipenem-cilastatin in the treatment of agranulocytosis and fever caused by chemotherapy in patients with malignant hematological diseases.Methods From July 2015 to July 2018,236 patients with malignant hematological diseases,agranulocytosis,and fever were selected from the Department of Hematology of our hospital.Retrospective analysis was used to analyze the clinical characteristics of agranulocytosis and fever after chemotherapy in patients with malignant hematological diseases and the clinical efficacy and safety of domestic imipenemcilastatin in the treatment of malignant hematological diseases.Results Most of the agranulocytosis infections were in the lung.There were 81 cases(34.3%)of pulmonary infection,37 cases(15.7%)of blood flow infection,and 29 cases(12.3%)of oral infection.A total of 104 strains of pathogens were cultured by bacterial culture.The most common strains were Klebsiella pneumoniae(17 strains),Escherichia coli(15 strains),Pseudomonas aeruginosa(15 strains),and Pseudomonas maltophilia(14 strains).In 61 strains of G-bacilli(excluding 14 strains of Pseudomonas maltophilia),the external drug sensitivity test showed that the sensitivity rate of imipenemcilastatin was 67.2%(41/61),and the sensitivity rate of imipenem was 94.9%in 39 strains of fermentative bacteriaand 50%in 22 strains of non-fermentative bacteria.In patients with agranulocytosis,the 24-hour antipyretic rate of domestic imipenem-cilastatin was 28%,the antipyretic rate of combination was 52.5%,and the total effective rate was 80.5%.The success rate of rescue of septic shock was 90.9%.The domestic imipenem-cilastatin was safe,and the main side effects were gastrointestinal reactions,such as nausea,decreased stomach volume(11.9%),nephrotoxicity,elevated creatine(11%),drug-induced liver damage(5%),and mental change(1.3%).All the patients could recover after drug withdrawal.Conclusion The domestic imipenem-cilastatin is safe and effective in the treatment of agranulocy

关 键 词：恶性血液病 粒细胞缺乏症 发热 亚胺培南/西司他汀 

分 类 号：R73[医药卫生—肿瘤]