大剂量舒巴坦联合碳青霉烯治疗CRAB医院获得性肺炎的疗效评价  

Efficacy evaluation of high-dose sulbactam combined with carbapenems in treatment of carbapenem resistant Acinetobacterbaumannii hospital-acquired pneumonia

作　　者：孙晓曼[1] 张立平[1] 王虹[2] 张英杰[1] 李培杰[3] Sun Xiaoman;Zhang Liping;Wang Hong;Zhang Yingjie;Li Peijie(Department of Neurosurgical Intensive Care Uni,the Lanzhou University Second Hospital,Lanzhou 730030,Gansu,China;Department of Respiratory Medicine,the Lanzhou University Second Hospital,Lanzhou 730030,Gansu,China;Department of Critical Care Medicine,the Lanzhou University Second Hospital,Lanzhou 730030,Gansu,China)

机构地区：[1]兰州大学第二医院神经外科ICU,甘肃兰州730030 [2]兰州大学第二医院呼吸科,甘肃兰州730030 [3]兰州大学第二医院重症医学科,甘肃兰州730030

出　　处：《中国中西医结合急救杂志》2022年第3期274-278,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：甘肃省自然科学基金(1506RJZA219);甘肃省兰州市科技计划项目(2020-ZD-100)。

摘　　要：目的 评价大剂量舒巴坦联合碳青霉烯治疗碳青霉烯耐药鲍曼不动杆菌(CRAB)感染医院获得性肺炎(HAP)的临床疗效及安全性.方法 选取2020年10月至2021年9月兰州大学第二医院神经外科重症监护病房(ICU)收治的42例CRAB感染肺炎确诊病例作为研究对象,均接受大剂量舒巴坦(8 g/d)联合碳青霉烯治疗,该方案治疗无效者转为大剂量舒巴坦联合多黏菌素B挽救性治疗方案;再根据碳青霉烯种类不同分为大剂量舒巴坦联合亚胺培南和大剂量舒巴坦联合美罗培南两个亚组,评价不同联合抗感染方案的疗效及安全性.结果 大剂量舒巴坦联合碳青霉烯类方案与大剂量舒巴坦联合多黏菌素B方案抗菌药物使用疗程相当(d:10.17±3.69比11.50±3.11,P>0.05);大剂量舒巴坦联合亚胺培南和大剂量舒巴坦联合美罗培南两亚组疗程比较差异无统计学意义(d:9.67±3.54比10.30±3.77,P>0.05).大剂量舒巴坦联合碳青霉烯类方案抗菌药物费用明显低于大剂量舒巴坦联合多黏菌素B挽救治疗方案(万元:1.08±0.40比5.70±1.48,P<0.05);大剂量舒巴坦联合亚胺培南和大剂量舒巴坦联合美罗培南两个亚组间抗菌药物费用比较差异无统计学意义(万元:0.91±0.34比1.12±0.41,P>0.05).大剂量舒巴坦联合碳青霉烯方案与大剂量舒巴坦联合多黏菌素B挽救治疗方案比较,无论是细菌清除率、治疗有效率还是28 d全因病死率比较差异均无统计学意义〔细菌清除率:57.1%(24/42)比100.0%(4/4),治疗有效率:88.1%(37/42)比100.0%(4/4),28 d全因病死率:9.52%(4/42)比25.00%(1/4),均P>0.05〕;大剂量舒巴坦联合美罗培南亚组方案细菌清除率、治疗有效率均高于大剂量舒巴坦联合亚胺培南方案〔细菌清除率:60.6%(20/33)比44.4%(4/9),治疗有效率:90.9%(30/33)比77.8%(7/9)〕,但差异无统计学意义(均P>0.05).大剂量舒巴坦联合碳青霉烯方案监测到14.3%(6/42)的患者肝酶升高超过正常参考值上限5倍,�Objective To evaluate the clinical efficacy and safety of high-dose sulbactam combined with carbapenems in the treatment of hospital-acquired pneumonia(HAP)caused by carbapenem resistant Acinetobacter baumanni(CRAB).Methods_Forty-two patients with HAP caused by CRAB admited to the department of neurosurgical intensive care unit(ICU)of Lanzhou University Second Hospital from October 2020 to September 2021 were selected as the research subjects.They were given high-dose sulbactam(8 g/d)combined with carbapenems for treatment,if the above treatment failed,high-dose sulbactam combined with polymyxin B as a salvage treatment.According to difference in carbapenems subtypes,the high-dose sulbactam combined with carbapenems group was subdivided into two subgroups:high-dose sulbactlam combined with imipenem subgroup and high-dose sulbactam combined with meropenem subgroup.The efficacy and safety of dfferent combined anti-infection programs were evaluated.Results The diference in treatment course between the high-dose sulbactam combined with carbapenems program and high-dose sulbactam combined with polymyxin B salvage therapy was of no statistical significant diference(days:10.17±3.69 vs.11.50±3.11,P>0.05);There was also no statistical significant dference in treatment course between the high-dose sulbactam combined with imipenem and high-dose sulbactam combined with meropenem subgroup(days:9.67±3.54 vs.10.30±3.77,P>0.05).The cost of antibiotics in high-dose sulbactam combined with carbapenems program was significantly lower than that in high-dose sulbactam combined with polymyxin B salvage therapy(ten thousands yuan:1.08±0.40 vs.5.70±1.48,P<0.05),but the cost of antibiotics had no statistical significant difference between the high-dose sulbactam combined with imipenem subgroup and high-dose sulbactam combined with meropenem subgroup(ten thousands yuan:0.91±0.34 vs.1.12±0.41,P>0.05).The bacterial clearance rate,clinical effective rate and 28-day all-cause morality were of no statistically significant differences b

关 键 词：舒巴坦 碳青霉烯类 碳青霉烯耐药鲍曼不动杆菌 医院获得性肺炎 

分 类 号：R978.11[医药卫生—药品] R563.1[医药卫生—药学]