多黏菌素E雾化吸入治疗多药耐药革兰阴性杆菌感染呼吸机相关性肺炎的临床疗效评价

Nebulized Colistin in Treatment of Ventilator-associated Pneumonia due to Multi-drug Resistant Gram-negative Bacteria:A Clinical Evaluation

目的评价多黏菌素E雾化吸入治疗多药耐药(MDR)革兰阴性菌感染所致呼吸机相关性肺炎(VAP)的临床效果及安全性。方法将41例MDR革兰阴性菌感染所致VAP的患者随机分为2组,对照组常规予目标性抗感染,试验组在对照组治疗的基础上加用多黏菌素E雾化吸入;疗效判断采用痊愈、显效、进步、无效4级标准评定,痊愈与显效合计为有效,细菌学评定按病原菌清除、部分清除、未清除、替换、再感染5级标准评定。结果试验组痊愈率为65.0%,有效率为90.0%;对照组痊愈率为28.8%,有效率为66.7%,两组痊愈率差异有统计学意义(P<0.05),有效率差异无统计学意义;试验组及对照组细菌清除率分别为87.0%和54.2%,差异有统计学意义(P<0.05);试验组未出现明显肾功能及神经系统损害。结论多黏菌素E雾化吸入辅助治疗MDR革兰阴性菌感染所致VAP有较好的临床效果,能较好的清除多药耐药菌,防止细菌定植,同时并不增加肾功能及神经系统损害。

OBJECTIVE To evaluate the efficacy and safety of nebulized colistin （polymyxin E） in the treatment of ventilator-associated pneumonia （VAP） due to multi-drng resistant （MDR） Gram-negative bacteria. METHODS In this randomized,controlled clinical trial,41 patients with VAP due to MDR Gram-negative pathogens were divided into two groups randomly.The control group was received targeted antimicrobial ,the treatment group was received targeted antimicrobial with nebulized colistin. The curative effect criterion was divided into：four standards of evaluationi the cure,excellence,improvement and inefficacy,the cure and excellence added up were considered efficacy. Bacteriological assessment standards：were divided into five standards of assessment：clear,some clear,unclear,replacement,and reinfection. RESULTS A total of 41 patients were enrolled. The clinical cure rates of treatment group and control group were 65.0%（13/20）and 28.8% （6/21）,and clinical efficacy rates were 90.0%（18/20） and 66.7%（14/21）,respectively. The bacterial eradication rate was 87.0% （20/23） in treatment group and 54.2% （13/24） in control group. The clinical cure rates and the bacterial eradication rate of two groups were with statistically significant difference （P〈0.05）,but the clinical efficacy rates of two groups were without statistically significant difference（P〉0.05）. The treatment group did not appear obvious renal function and nervous system damage. CONCLUSIONS Nebulized colistin may be a beneficial adjunctive treatment in the management of VAP due to MDR Gram-negative bacteria. Nebulized colistin can be able to clear the MDR Gram-negative bacteria and to prevent bacterial colonization.