耐多药肺结核24例临床分析

Multi-drug resistant pulmonary tuberculosis: clinical analysis of 24 cases

为分析耐多药肺结核的成因并探讨治疗对策，对２４ 例耐多药肺结核患者病史进行分析。痰结核菌检测及药敏测试，用３ＡＫＨＰＯＸ／ＨＰＯＸ 方案治疗并观察痰、胸片变化及药物毒副作用，有适应证者行外科手术加内科治疗。结果表明：ＭＤＲ－ ＰＴＢ７５ ％ 由不规则化疗引起，包括医师、患者及药物等诸多人为因素；２５ ％ 为初始耐药。内科治疗近期有效率为８３ ％ ，停药２ 年痰菌复发率为１２ ．５ ％ ，外科手术加内科治疗近、远期疗效均好。提示加强宣教、强调结核病归口管理，提高综合医院医师对结核病的认识，保证初治患者治疗规则、彻底，是防止ＭＤＲ－ ＰＴＢ 产生的关键，对ＭＤＲ－ ＰＴＢ采用含大剂量异烟肼。

To analyse the cause resourses of multi-drug resistant pulmonary tuberculosis (MDR-PTB) and its therapy, case history of 24 patients were reviewed. Sputum examination for tubercle bacillus and drug senitive test had been done for them. Patients received 3AKHPOX/HPOX regimen and sputum, chest X-ray film changes and side-effects had been evaluated. Patients with indication received medical and surgical treatment. 75% MDR-PTB induced by irregular chemotherapy, including human factors as doctors, patients and drugs; 25% preliminary drug resistance. Short-term effective rate of medical treatment was 83%, recurrence rate of sputum cells two years after stopping drugs was 12.3%. Both short term and long term treatment of medical and surgical therapies had good results. It indicated that the key to preventing MDR-PTB is that physicians should know more about tuberculosis and give patients complete regular treatment. It is safe and effective for the treatment of MDR-PTB with high dose isoniazid, ofloxacin and other second drugs.