莫西沙星联合头孢哌酮/舒巴坦治疗严重脓毒症或脓毒性休克的临床观察

Clinical Research of Moxifloxacin Combined with Cefoperazone/Sulbactam in the Treatment of Sepsis Complicating with Multiple Organ Dysfunction

目的：比较莫西沙星联合头孢哌酮／舒巴坦与单用美罗培南治疗严重脓毒症或脓毒性休克的临床效果。方法：将91例在重症监护病房（ICU）治疗的、符合严重脓毒症或脓毒性休克标准的患者随机分为观察组（46例）和对照组（45例），观察组患者给予静脉滴注头孢哌酮／舒巴坦和莫西沙星治疗，对照组患者给予静脉滴注美洛培南治疗。两组患者的疗程均为7～14d。两组患者均于治疗前、治疗后、治疗第21天或脱离ICU时分别开展临床、微生物和实验室检查。比较两组患者治疗前后的器官衰竭程度、中位退热时间、细菌学疗效、死亡率、患者住ICU和住院天数以及不良反应的发生情况。结果：两组患者的序贯器官衰竭（SOFA）评分、中位退热时间和细菌清除率比较，差异均无统计学意义（P〉0．05）；两组患者不良反应比较差异无统计学意义（P〉0．05）。两组患者的28d和90d内死亡率、住ICU和住院天数及呼吸系统SOFA分项得分}匕较，差异有统计学意义（P〈0．05）。结论：莫西沙星联合头孢哌酮／舒巴坦临床疗效确切，可以降低严重脓毒症或脓毒性休克患者的死亡率，并能缩短住ICU和住院的时间。

OBJECTIVE： To compare the effects of moxifloxacin combined with cefoperazone/sulbactam vs. meropenem alone in the treatment of sepsis complicating with multiple organ dysfunction. METHODS： 91 patients treated in the intensive care unit, in line with standard severe sepsis or septic shock, were randomly divided into observation group （46 cases） and control group （45 cases）. Observation group was given intravenous drip of cefoperazone/sulbactam and moxifloxacin; control group was given intravenous drip of meropenem. Treatment course of 2 groups lasted for 7-14 days. Clinical test, microbiological test and laboratory test were performed in both groups before treatment, after treatment, on 21st day of treatment, or discharged from the intensive care unit. The degree of organ failure, median fever clearance time, bacteriological efficacy, mortality, hospital stay of patients in the ICU and hospital as well as the incidence of adverse drug reactions were compared between 2 groups before and after treatment. RESULTS： The sequential organ failure （SOFA） score, median fever clearance time and bacterial clearance rate had no statistical sig- nificance （P〉0.05） ; there was no statistical significance in the incidence of ADR between 2 groups （P〉0.05）. There were statistical significances in mortality within 28 d and 90 d, length of stay in the ICU and hospital, respiratory SOFA score between 2 groups （P〈0.05）. CONCLUSIONS： Moxifloxacin combined with cefoperazone/sulbactam is effective and can reduce the mortality of patients with severe sepsis and shorten the length of hospital stay.