32例耐多药肺结核治疗的临床分析

Analysis on clinical treatment of 32 cases pulmonary tuberculosis with multi-drug resistance

目的探讨耐多药肺结核的合理治疗方案。方法收集32例耐多药肺结核患者的临床资料。2000年之前为第1组、2001年之后为第2组回顾性分析其治疗方案、手术情况和治疗转归。结果 32例耐多药肺结核患者中有耐药结核接触史者14例。治愈19例(59.4%)。第1组治愈率为38.5%,与选择敏感药物种数不足有关。第2组治愈率提高至73.7%,治疗失败主要与血糖控制不理想和广泛耐药有关。结论对有耐药肺结核接触史的患者应提高警惕,早期发现原发耐多药肺结核。选择4种或4种以上的敏感药物组成有效方案是提高耐多药肺结核治愈和手术治疗成功的关键。

Objective To explore rational therapeutic schedule of treatment to multi-drug resistant pulmonary tuberculosis （MDR-PTB）. Methods Clinical data of 32 cases with MDR-PTB were retrospectively analyzed from 1989 to 2009. Before the year of 2000 was divided into the first group, after the year of 2001 was divided into the second group. Therapeutic regime, operation condition and treatment prognosis were analyzed. Results Fourteen cases had TB contact history, 19 cases were cured （59.4%）. The cure rates was only 38.5% in the first group, 73.7% in the second group. Treat- ment failure mainly respectively related to inadequate of sensitive drugs, poor control of blood glucose and extensively drug-resistance in two groups. Conclusions The patients with MDR-PTB contact history should be paid more attention to detect early primary MDR-PTB. It is critical to choose 4 or more kinds of sensitive drugs for improvement of cure rates with MDR-PTB and operation treatemt.