非抗菌疗法在泛耐药菌珠所致老年重症肺部感染疾病治疗中的可行性研究

The feasibility study of non antibiotic therapy on elderly severe pulmonary infection caused by pan-drug-resistant strains

目的：探讨非抗生素治疗手段在泛耐药菌珠所致老年重症肺部感染疾病治疗中的可行性。方法选取2010年4月－2012年9月机械通气患者81例，根据治疗方案不同将患者分为A组36例及B组45例。 A组治疗措施主要为应用胸腺肽类药物、丙种球蛋白免疫调节剂和血必净，每天进行1～2次的气管镜吸引及灌洗等。 B组在A组的基础上继续给予经验性抗生素治疗。比较2组APACHEⅡ评分、白细胞数、体温及耐药性。结果 A组患者致病菌的耐药性由原来的100．0％广泛耐药特性降至55．2％，而B组患者致病菌耐药性未见明显改变；而白细胞含量经过非抗生素处理干预治疗后的A组白细胞数量有所下降，且与治疗前比较差异有统计学意义（P＜0．05）。治疗1个月，A组死亡2例，病死率为5．6％，而B组死亡10例，病死率为22．2％，差异有统计学意义（P＜0．01）。结论非抗生素治疗可使患者致病菌耐药性下降，降低病死率，具有可行性。

Objective To investigate the feasibility of non antibiotic therapy on elderly severe pulmonary infection caused by pan-drug-resistant strains .Methods From April 2010 to September 2012 ,81 cases of patients with mechanical ven-tilation were divided into group A （36 cases） and group B （45 cases）,according to the different treatments .The group A was mainly given thymic peptide drugs ,gamma globulin immune modulators and Xuebijing for treatment ,and received bronchoscope attraction for 1～2 times a day and irrigation ,etc.On the basis of group A ,the group B continued to be given empirical antibiot-ic treatment.The APACHE Ⅱ score,the number of white blood cell ,temperature and drug resistance of 2 groups were com-pared.Results In group A,the drug resistance of pathogenic bacteria decreased from the original 100% to 55.2%,but pa-tients in the B group had no obvious changes in pathogen resistance .After the non antibiotic treatment intervention treatment , the number of white blood cells decreased in group A ,the difference was statistically significant （P〈0.05）,compared with be-fore treatment.After 1 months of treatment,2 cases died in group A,the mortality rate was 5.6%,but 10 cases died in group B,the mortality rate was 22.2%,the difference was statistically significant （P〈0.01）.Conclusion The antibiotic treatment can make patients pathogenic bacteria resistance drop ,reduce the case fatality rate and has the feasibility .