支气管扩张症患者早期应用哌拉西林/他唑巴坦的临床价值

Value of early application of piperacillin/tazobactam in treatment of bronchiectasis

目的评估支气管扩张症患者早期应用哌拉西林/他唑巴坦的临床价值。方法根据支气管扩张症患者痰量及性状的早期改变,提早短期静脉滴注哌拉西林/他唑巴坦,通过痰细菌学检查及其他临床表现等评价临床价值。结果 17例支气管扩张症患者的定植/致病菌以铜绿假单胞菌最常见;针对性地进行5～7d的哌拉西林/他唑巴坦提早治疗,患者痰量及性状、痰致病菌量恢复如前,且未发生细菌交替及耐药的增加;2011年1-6月未发生严重的急性感染发作;超敏C-反应蛋白随咳痰及菌量同步变化,该次入院时为(10.6±2.0)mg/L,均极显著地高于前次出院时的(3.9±0.7)mg/L及该次出院时的(4.1±1.3)mg/L(P<0.01),而其他临床表现始终未发生明显改变。结论根据咳痰的早期变化,提早应用哌拉西林/他唑巴坦可以减低支气管扩张症患者肺部细菌负荷,抑制严重急性感染的发生,而超敏C-反应蛋白可作为一个辅助判断的指标。

OBJECTIVE To evaluate the clinical value of early application of piperacillin/tazobactam （4 ： 1） in treatment of bronchiectasis. METHODS The patients with bronchiectasis were treated with piperacillin/tazobactam （4 ： 1） in the early stage according to prophase change of the volume and characteristics of sputum. The clinical value was assessed through bacteriology examination and other clinical manifestations. RESULTS Among 17 adaptive patients with bronchiectasis, Pseudornonas aeruginosa strains were the＇ most common colonized pathogens; after the patients were treated with piperacillin/tazobactam （4 ： 1） for 5- 7 days, the volume, characteristics and bacterial burden of their sputum recovered to the levels of the stable stage; the species of bacteria and drug resistance were not changed; moreover, there wasn＇t severe acute infection attack that occurred from Jan to Jun 2011; supersensitive C-reaction protein changed to follow the sputum： （10.6±2.0）mg/L on the admission was obviously higher than （3.9 ± 0.7）mg/L on last discharge and （4.1 ±1.3）mg/L on this discharge （P〈0. 01）, but other clinical manifestations didn＇t change. CONCLUSION Earlier treatment with piperacillin/ tazobactam （4 ：1） according to prophase changes of the sputum will decrease bacterial burden in the lung of patients with bronchiectasis and inhibit severe acute infection attack, supersensitive C-reaction protein may be a supportive indictor for evaluation.