硫酸多黏菌素B治疗耐碳青霉烯类革兰阴性菌脓毒症的疗效  

Efficacy of polymyxin B sulfate in treatment of carbapenem-resistant gram-negative bacteria sepsis

作　　者：张金龙 邹俊杰 王漾漾 郭嘉惠 王璐 ZHANG Jin-long;ZOU Jun-jie;WANG Yang-yang;GUO Jia-hui;WANG Lu(Zhongda Hospital Affiliated to Southeast University,Nanjing,Jiangsu 210003,China)

机构地区：[1]东南大学附属中大医院药学部,江苏南京210003

出　　处：《中华医院感染学杂志》2024年第21期3226-3230,共5页Chinese Journal of Nosocomiology

基　　金：江苏省卫生健康委医学科研基金资助项目(JH19090)。

摘　　要：目的探讨硫酸多黏菌素B治疗耐碳青霉烯类革兰阴性菌(CRGNB)脓毒症疗效。方法收集2020年3月-2022年3月东南大学附属中大医院接收的110例CRGNB脓毒症患者临床资料,依据是否联用硫酸多黏菌素B分为对照组48例和联合组62例。对比两组疗效、外周血和肾功能指标及预后情况。结果排除7 d内死亡病例后,纳入对照组39例、联合组58例,联合组疗效率高于对照组(P<0.05),细菌清除率74.14%高于对照组46.15%(P<0.05);治疗后两组亚群调节性T细胞/辅助性T细胞17、C-反应蛋白、肿瘤坏死因子-α及白细胞介素-6均下降,联合组治疗前后差值大于对照组(P<0.05),两组胱抑素C、血尿素氮及肌酐均上升,联合组治疗前后差值大于对照组(P<0.05)。联合组7 d病死率低于对照组(P<0.05);两组14、28 d病死率及不良反应发生率比较,无统计学差异。结论硫酸多黏菌素B联用可下调CRGNB脓毒症患者外周血炎症因子水平,对肾功能影响较小,有助于改善预后,疗效确切。OBJECTIVE To explore the effect of polymyxin B sulfate on treatment of carbapenem-resistant gram-negative bacteria(CRGNB)sepsis.METHODS A total of 110 patients with CRGNB sepsis who were treated in Zhongda Hospital Affiliated to Southeast University from Mar.2020 to Mar.2022 were enrolled in the study and were divided into the control group with 48 cases and the combined group with 62 cases according to the status of combined use of polymyxin B sulfate.The clinical data were collected from the patients.The curative effect,peripheral blood and renal function indexes as well as treatment outcomes were observed and compared between the two groups.RESULTS Totally 39 cases were included in the control group,and 58 cases were included in the combined group after the patients who died within 7 days were excluded.The effective rate of trentment of the combined group was higher than that of the control group(P<0.05).The bacterial eradication rate of the combined group was 74.14%,higher than 46.15%of the control group(P<0.05).The levels of subsets regulator T lymphocyte/helper T cell 17,C-reactive protein,tumor necrosis factor-αand interleukin-6 of the two groups were lower after the treatment than before the treatment,and the different values of above indexes between pretreatment and posttreatment were greater in the combined group than in the control group(P<0.05).The levels of cystatin C,blood urea nitrogen and creatinine of the two groups were higher after the treatment than before the treatment,and the difference values of above indexes between pretreatment and posttreatment were greater in the combined group than in the control group(P<0.05).The 7-day mortality rate of the combined group was lower than that of the control group(P<0.05);there were no significant differences in the 14-day,28-day mortality rates or incidence of adverse reactions between the two groups.CONCLUSION The combined use of polymyxin B sulfate can downregulate the levels of peripheral blood inflammatory factors of the patients with CRGNB sepsis

关 键 词：硫酸多黏菌素B 耐碳青霉烯类革兰阴性菌 脓毒症 疗效 预后 

分 类 号：R631[医药卫生—外科学]