血液肿瘤患者粒细胞缺乏症合并感染的抗生素治疗

The exploration of antibiotic therapy in neutropenic hematological maligence patients

目的探讨血液肿瘤患者粒细胞缺乏症并感染的经验性抗生素治疗.方法回顾性分析125例血液肿瘤患者的260例次的临床资料,观察哌拉西林/他唑巴坦（特治星,TAZ,tazocin）、头孢他啶（CTZ,ceftazidime）、亚胺培南/西司他丁（泰能,IMP,imipenem）、盐酸头孢吡肟（其他名称：马斯平,Maxipime）与丁胺卡那霉素（AMK,amikacin）分别组成TA、CA、IA、MA方案的疗效及副作用.结果TA、CA、IA、MA方案分别治疗45、80、75、60例次,治疗中位时间为7～8 d,有效率分别为65%、48%、70%、79%,CA方案明显为低（P＜0.05）.治疗无效者调整治疗：改用TA、IA或MA方案加减去甲万古霉素（NVC,norvancomycin）及抗真菌治疗;总有效率分别为88%、83%、86%和91%.最常见副作用为胃功能紊乱,腹泻为12%,皮疹和肝转氨酶轻度升高分别为4%;2例NVC和AMK治疗者出现明显的听力下降和肾脏毒性.结论TA、IA、MA方案具有相似的疗效,可作为一线经验性治疗方案.经验治疗无效者,应改用具有更高抗菌活性的方案或尽早采用NVC和（或）抗霉菌治疗.

Objective To compare the efficiency and safety of regimens of empiric antibiotic therapy in neutropenic hematological maligence patients. Methods The clinical data of empiric antibiotic therapy for 260 febrile episodes in 125 neutropenic hematological maligence patients were analyzed retrospectively. Results A total of 45 febrile episodes were treated with tazocin plus amikacin（regimen TA）. 80 episodes were treated with ceftazidime plus amikacin（regimen CA）,75 episodes with imipenem plus amikacin（regimen IA） and 60 episodes with maxipime plus amikacin（regimen MA）. The medians of initial therapy in each regimen were 7-8 days. Percentage of satisfactory response had no significant difference in episodes treated with regimens TA, IA and MA（65% ,70% and 79% respectively） ,and it was better than regimen CA（P 〈 0.05）. Regimen CA was modified in more than half of all the episodes, and the percentage was higher than other regimens（ P 〈 0.05 ）. Norvancomycin was added in almost half of all the episodes in each regimen. Antifungals were added at about 40 % -60 % episodes in all regimens. The overall success rates were 88 %, 83 %, 86 % and 91%, respectively. Each regimen was generally well tolerated. In all treatment groups, 12 % of episodes had diarrhea, 4 % had rash and 4 % had mild liver dysfunction. Two cases which were treated with norvancomycin and amikacin had clear poor hearing and kidney toxicity. Conclusion Regimen TA, IA and MA should still be reserved for first line therapy in neutropenic hematological maligence patients,which are generally well tolerated. In order to improve response rate for unresponsive patients to initial empiric therapy initial empiric regimen should be modified or introduced early norvancomycin and（or） the antifungal agents.