雾化吸入阿米卡星治疗鲍曼不动杆菌呼吸机相关肺炎的效果和安全性分析

The efficacy and safety of aerosolized amikacin therapy in ventilator-associated pneumonia caused by Acinetobacter baumannii

目的评估雾化吸入阿米卡星治疗鲍曼不动杆菌呼吸机相关肺炎的效果和安全性。方法将56例鲍曼不动杆菌呼吸机相关肺炎患者随机分为对照组和研究组各28例。对照组在头孢哌酮舒巴坦钠(3.0 g,1次/12 h)阿米卡星注射液(7.5 mg/kg,1次/d)静脉治疗的同时予生理盐水(5 ml,1次/d)呼吸机雾化吸入,研究组在头孢哌酮舒巴坦钠(3.0 g,1次/12 h)静脉治疗的同时予阿米卡星注射液(7.5 mg/kg,1次/d)呼吸机雾化吸入,分析治疗8 d后两组的支气管肺泡灌洗液培养结果转阴率、急性生理与慢性健康评分Ⅱ(APACHEⅡ)、临床肺部感染评分(CPIS)、氧合指数(Pa O2/Fi O2)、尿量及血肌酐(Cr)水平的变化,随访28 d,记录死亡率。结果治疗后,研究组与对照组支气管肺泡灌洗液培养转阴率分别为82.1%(23/28)、53.6%(15/28),差异有统计学意义(P<0.05)。治疗后,两组APACHEⅡ、CPIS较治疗前均下降,Pa O2/Fi O2均明显提高(P﹤0.05)。与治疗前相比,对照组尿量减少,Cr水平升高(P<0.05);而研究组尿量增多,血肌酐无明显变化(P>0.05)。治疗后对照组的尿量明显少于研究组,Cr水平明显高于研究组,差异有统计学意义(P<0.05)。研究组和对照组28 d死亡率分别为21.4%(6/28)、25.0%(7/28),差异无统计学意义(P>0.05)。结论雾化吸入阿米卡星治疗鲍曼不动杆菌呼吸机相关肺炎效果好,肾脏毒性小,能减少全身静脉应用抗生素的剂量。

Objective To assess the efficacy and safety of aerosolized amikacin therapy in ventilator-associated pneu-monia （VAP） caused by Acinetobacter baumannii. Methods 56 patients with VAP caused by Acinetobacter baumannii were randomly divided into control group and study group,28 patients in each group.The control group were given with cefoperazone sulbactam sodium （3.0 g,1 time/12 h） amikacin injection （7.5 mg/kg,1 time/d） intravenous therapy while saline （5 ml,1 time/d） ventilator inhalation;the study group were given with cefoperazone sulbactam sodium （3.0 g,1 time/12 h） intravenous therapy while amikacin injection （7.5 mg/kg,1 time/d） ventilator inhalation.After 8 days treatment,the changes of bronchoalveolar lavage （BAL） culture negative rate,acute physiology and chronic health evaluation II（APACHEII）,clinical pulmonary infection score （CPIS）,oxygenation index （PaO2/FiO2）,urine volume and serum creati-nine （Cr） were analyzed;mortality rate of 28 days follow-up was recorded. Results After treatment,the negative rate of BAL fluid culture was 82.1% and 53.6% in study group and control group,respectively,the difference was significant （P〈0. 05）. APACHEII and CPIS were decreased,while PaO2/FiO2 were increased in the two groups compared with before treatment （P〈0. 05）;Compared with before treatment,urine volume were decreased while Cr increased in the control group （P〈0.05）,but urine volume were increased,Cr had no significant changes in study group （P〉0.05）.After treatment, urine volume of control group were less than that of the study group,Cr was higher than that of study group,the differ-ence was significant （P〈0. 05）. Mortality rate of 28 days in study group and control group was 21.4%and 25.0%respec-tively,the difference was not significant （P〉0.05）. Conclusion Aerosolized amikacin therapy in VAP caused by Acine to-bacter baumannii has better efficacy,the toxicity of kidney is less,it can reduce the dose of intravenous antibiotics.