阿米卡星联合哌拉西林他唑巴坦钠治疗老年重症肺炎的临床疗效  

Clinical efficacy of amikacin combined with piperacillin-tazobactam sodium in treatment of elderly patients with severe pneumonia

作　　者：于季红[1] 闫中强[2] 赵秀梅[1] 田亚平[1] YU Ji-hong;YAN Zhong-qiang;ZHAO Xiu-mei;TIAN Ya-ping(Medical Innovation Research Division of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院医学创新研究部临床生物样本中心,北京100853 [2]解放军总医院第二医学中心疾病预防控制科,北京100853

出　　处：《中华医院感染学杂志》2020年第18期2759-2763,共5页Chinese Journal of Nosocomiology

基　　金：“十三五”科技重大专项基金资助项目(2018ZX10733402)。

摘　　要：目的探讨阿米卡星和哌拉西林他唑巴坦钠治疗老年重症肺炎的临床疗效。方法选取2018年10月-2019年10月解放军总医院90例老年重症肺炎患者为研究对象,统计患者治疗前病原菌和多重耐药菌分布情况,采用随机数字法平均分为A、B、C三组。A组30例患者采用阿米卡星联合哌拉西林他唑巴坦钠治疗,B组30例患者仅采用阿米卡星治疗,C组30例患者仅采用哌拉西林他唑巴坦钠治疗。比较三组患者的病原菌清除率、白细胞计数(WBC)、中性粒细胞百分比(NE%)、C-反应蛋白(CRP)和降钙素原(PCT)等检验指标,观察临床表现及不良反应情况。结果90例老年重症肺炎患者共检出193株病原菌,其中革兰阴性菌142株(73.58%),革兰阳性菌51株(26.42%);A、B、C三组患者治疗后的总病原菌清除率分别为95.31%、92.19%和89.23%,A组的总病原菌清除率略高于B组和C组,但比较差异无统计学意义;治疗前后三组患者WBC、CRP和PCT的差值比较均有统计学意义(P<0.05),三组间NE%差值比较无统计学意义;三组患者平均发热时间、平均机械通气时间和平均痰液颜色改变时间比较差异均有统计学意义(P<0.05),平均肺部炎症吸收改变时间比较差异无统计学意义;A组和C组在不良反应和副作用总发生率上明显低于B组。结论耐药铜绿假单胞菌感染在老年重症肺炎患者中占有较高比例,与单独采用单一抗生素治疗相比,联用阿米卡星和哌拉西林他唑巴坦钠可以获得更好的治疗效果并可有效降低不良反应和副作用,具备一定的临床推广价值。OBJECTIVE To explore the clinical efficacy of amikacin combined with piperacillin-tazobactam sodium in treatment of elderly patients with severe pneumonia.METHODS A total of 90 elderly patient with severe pneumonia who were treated in Chinese PLA General Hospital from Oct 2018 to Oct 2019 were recruited as the study objects,the distribution of pathogens and multidrug-resistant organisms was statistically analyze before the treatment,the enrolled patients were randomly divided into the group A with 30 cases,the group B with 30 cases,and the group C with 30 cases.The group A was treated with amikacin combined with piperacillin-tazobactam sodium,the group B was only treated with amikacin,and the group C was only treated with piperacillin-tazobactam sodium.The test indexes such as clearance rate of pathogens,white blood cell(WBC),percentage of neutrophils(NE%),C-reactive protein(CRP)and procalcitonin(PCT)were compared among the three groups of patients,and the clinical manifestations and adverse reactions were observed.RESULTS Totally 193 strains of pathogens were isolated from the 90 elderly patients with severe pneumonia,142(73.58%)of which were gram-negative bacteria,and 51(26.42%)were gram-positive bacteria.The total clearance rate of pathogens was 95.31%in the group A after the treatment,92.19%in the group B,89.23%in the group C,the total clearance rate of pathogens of the group A was slightly higher than that of the group B and the group C,however,there was no significant difference;There were significant differences in WBC,CRP and PCT among the three groups of patients after the treatment(P<0.05),there was no significant difference in NE%among the three groups.There were significant differences in the average fever time,average time of mechanical ventilation and average time of among the three groups of patients(P<0.05),there was no significant difference in the average time of change of lung inflammation absorption.The total incidence of adverse reactions and side effects were remarkably lower in the group A

关 键 词：阿米卡星 哌拉西林他唑巴坦钠 老年重症肺炎 临床疗效 

分 类 号：R563.1[医药卫生—呼吸系统]