尿毒症患者肺部感染抗菌药物治疗分析

Antibiotics treatment of pulmonary infections in patients with uremia

目的：探讨尿毒症患者肺部感染抗菌药物应用最佳疗程，为该类患者抗感染治疗提供参考。方法回顾性分析2003年1月－2012年12月386例尿毒症患者发生肺部感染住院489例次临床资料，统计分析抗菌药物联合应用率、抗菌药物疗程、药物不良反应与预后的关系。结果抗菌药物联合用药较单用多，联合用药共有268例次、单用221例次；抗菌药物疗程＞14 d者108例次、11-14 d的128例次、7-10 d的201例次、＜7 d的52例次，常见不良反应为消化道症状、二重感染和神经系统症状，抗菌药物疗程＞14 d的108例次患者中并发二重感染率较高，其中22例次加用抗真菌药物，占20．37％，较其他疗程组差异有统计学意义（ P＜0．01）；386例患者死亡18例，病死率4．66％，其中重症监护病房死亡8例，病死率19．05％。结论适当的抗菌药物疗程能减少其不良反应，盲目延长疗程并不能增加治愈率，相反会增加二重感染等抗菌药物严重不良反应的发生概率，抗菌药物疗程一般＜10d，特殊感染可延长至14d，轻中度炎症可将疗程缩短至5-7d，抗菌药物合理联用能增加治愈率。

OBJECTIVE To explore the optimal course of antibiotics treatment of the uremia patients with pulmona‐ry infections so as to provide guidance for treatment of infections in such group of patients .METHODS The clinical data of 386 （489 case‐times） uremia patients complicated with pulmonary infections who were hospitalized from Jan 2003 to Dec 2012 were retrospectively analyzed ,and the relationship between the rate of combination use of antibiotics ,antibiotics treatment course ,drug‐induced adverse reactions ,and prognosis was statistically analyzed . RESULTS The number of cases of combination drug therapy was larger than that of cases of single drug therapy , there were totally 268 cases‐times of combination drug therapy and 221 case‐times of single drug therapy .There were 108 case‐times with the antibiotics treatment course more than 14 days ,128 case‐times with the treatment course ranging between 11 and 14 days ,201 case‐times with the treatment course ranging between 7 and 10 days , and 52 case‐times with the treatment course less than 7 days .The gastrointestinal symptoms ,secondary infec‐tions ,and neurological symptoms were the common adverse reactions .The incidence of secondary infections was high in the 108 cases‐times of patients with the antibiotics treatment course more than 14 days ,and 22 case‐times of patients were additionally treated with antifungal agents ,accounting for 20 .37% ,as compared with other treat‐ment course groups ,there was significant difference （P〈0 .01） .Totally 18 of 386 patients died with the mortality rate of 4 .66% ,including 8 （19 .05% ） cases who died in the intensive care unit .CONCLUSION The appropriate antibiotics treatment course may reduce the incidence of adverse reactions ,while extending the treatment course blindly can not raise the cure rate and on the contrary may increase the incidence of secondary infections as well as the incidence of antibiotics‐induced severe adverse reactions .The antibiotics treatment course is generally less than 10 days ,extending to 14 days for the special infections and shortening to 5 to 7 days for mild and moderate inflam‐mation ;the reasonable combination use of antibiotics can raise the cure rate .