雾化吸入多黏菌素B治疗血液重症患者多重耐药革兰阴性菌肺炎的临床疗效分析  

Clinical efficacy analysis of polymyxin B atomization treatment in severe blood disease patients with multidrug-resistant gram-negative pneumonia

作　　者：魏求哲 卢聪[1] 谢沁颖 江慧雯 吴耀辉[1] 胡俊斌[1] 曹谢娜 WEI Qiuzhe;LU Cong;XIE Qinying;JIANG Huiwen;WU Yaohui;HU Junbin;CAO Xiena(Hematology Intensive Care Unit,Department of Hematology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院血液内科,重症监护病房,武汉430022

出　　处：《临床血液学杂志》2025年第1期14-19,30,共7页Journal of Clinical Hematology

摘　　要：目的:回顾性分析多重耐药(MDR)革兰阴性菌(GNB)感染重症肺炎的血液病患者加用多黏菌素B雾化治疗患者的临床资料。方法:收集华中科技大学同济医学院附属协和医院血液重症病房(HCU)2022年12月—2023年7月收治的48例MDR-GNB感染的重症肺炎的血液病患者资料。依据多黏菌素优化应用国际共识指南雾化吸入治疗(25 mg,12 h 1次,振动筛孔雾化吸入),观察患者使用疗程结束后的有效率、治疗前后感染指标C反应蛋白(CRP)及血清降钙素原(PCT)水平的变化。结果:48例患者痰/血培养或病原微生物二代测序结果显示:耐碳青霉烯阴沟肠杆菌/大肠埃希菌13例,鲍曼不动杆菌8例,铜绿假单胞菌6例,肺炎克雷伯菌4例,嗜麦芽窄食单胞菌4例,其他为少见病原菌或者疑似MDR感染患者;其中合并新型冠状病毒感染患者10例。动态分析治疗过程中感染指标CRP和血清PCT水平的变化:治疗后3 d CRP水平较治疗前开始下降[(94.06±71.30)mg/L vs(70.55±58.04)mg/L],治疗后7 d[(94.06±71.30)mg/L vs(46.40±40.93)mg/L,P<0.01]以及治疗后14 d[(94.06±71.30)mg/Lvs(47.93±51.08)mg/L,P<0.01]显著下降,差异有统计学意义。PCT水平在治疗后7 d也开始出现明显下降[(5.15±12.14)μg/Lvs(3.76±5.00)μg/L],与CRP变化一致。治疗前后,患者凝血功能、胆红素以及肌酐水平无明显变化,无肝肾功能损害(P>0.05)。结论:血液重症患者常合并重度免疫缺陷,治疗MDR-GNB感染的肺炎使用多黏菌素B联合其他抗生素治疗有效,感染指标在治疗14 d内呈动态下降趋势,可以提高挽救性治疗合并新型冠状病毒感染重症患者的疗效。Objective:This study was conducted to retrospectively analyze the clinical data of blood disease patients with severe pneumonia caused by multidrug-resistant(MDR)gram negative bacteria(GNB)who were treated with nebulization of polymyxin B.Methods:Collect data of 48 blood disease patients with severe pneumonia caused by MDR-GNB infection who were admitted to the Hematology Intensive Care Unit(HCU)of Wuhan Union Hospital from December 2022 to July 2023.According to the international consensus guidelines for optimizing the application of polymyxin,nebulization therapy(25 mg,once every 12 hours,vibrating sieve nebulization inhalation)was applied to these patients.The effective rate,changes in infection markers such as C-reactive protein(CRP)and serum procalcitonin(PCT)levels were observed after the treatment course.Results:The results of Sputum/blood cultures or second-generation sequencing of pathogenic microorganisms from 48 patients showed that 13 patients were infected by carbapenem resistant Enterobacter cloacae/Escherichia coli,8 patients were infected with Acinetobacter baumanni,6 patients were infected with Pseudomonas aeruginosa,4 patients were infected with Klebsiella pneumoniae,4 patients were infected with Stenotrophomonas maltophilia,and others were infected with rare pathogenic bacteria or suspected MDR-GNB;Among them,10 patients had co-infection with COVID-19.Dynamic analysis of changes in infection markers CRP and PCT during treatment indicated that CRP levels began to decrease after 3 days of treatment[(94.06±71.30)mg/L vs(70.55±58.04)mg/L],and kept decreasing at 7 days[(94.06±71.30)mg/L vs(46.40±40.93)mg/L,P<0.01]and 14 days[(94.06±71.30)mg/L decrease obviously after 7 days of treatment(5.15±12.14)μg/L vs(3.76±5.00)μg/L],which was consistent with changes in CRP.During the entire course of treatment,there were no significant changes in coagulation function,bilirubin,and creatinine levels among these patients,and no liver or kidney function damage(P>0.05).Conclusion:Patients with severe blood

关 键 词：多黏菌素B 雾化吸入 多重耐药革兰阴性菌肺炎 血液重症患者 临床疗效 

分 类 号：R563[医药卫生—呼吸系统] R55[医药卫生—内科学]