美罗培南联合头孢哌酮/舒巴坦与米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎的临床观察

Meropene and cefoperazone sulbactam associated with minocycline in the treatment of patients with ventilator-associated pneumonia caused by universal drug-resistant acinetobacter baumannii

目的观察美罗培南、头孢哌酮/舒巴坦、米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎的临床疗效。方法选择泛耐药鲍曼不动杆菌性呼吸机相关肺炎患者48例,应用5%葡萄糖（生理盐水）100 ml＋美罗培南2 g静脉滴注,1次/8 h,60 min滴入;5%葡萄糖（生理盐水）100 ml＋头孢哌酮/舒巴坦3 g静脉滴注,1次/8 h,60 min滴入;米诺环素0.1 g鼻饲,3次/d;联合治疗10-14 d。观察临床疗效、细菌清除率、肝肾功能、C反应蛋白、降钙素原、血常规和不良反应。结果联合抗菌治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎,临床治愈率62.50%,有效率75.00%,细菌清除率62.50%;对肝肾功能无明显影响,无明显不良反应。结论美罗培南、头孢哌酮/舒巴坦、米诺环素联合治疗泛耐药鲍曼不动杆菌性呼吸机相关肺炎效果较好。

Objective To observe the clinical effects of meropene and cefoperazone sulbactam associated with minocycline on the patients with ventilator-associated pneumonia caused by universal drug-resistant acinetobacter baumannii. Methods Forty-eight patients with ventilator-associated pneumonia caused by PDRAB were respectively treated for a succession of 10 to 14 days with the following regimens： 60-min intravenous infusion of 100 ml physiological saline ＋ 2 g meropene once every 8 hours; 60-min intravenous infusion of 100 ml physiological saline ＋ 3 g cefoperazone sulbactam associated with minocycline also once every 8 hours; and 0. 1g minocycline nasal gavage three times a day. Then,clinical therapeutic effects,bacterial clearance,hepatorenal function,C-reactive protein,calcitonin,blood routine and adverse drug reactions were observed closely. Results The clinical cure rate of combined drugs in the treatment of ventilator-associated pneumonia caused by universal drug-resistant acinetobacter baumannii was 62. 50%,the effective rate was 75. 00%,and the bacterial clearance rate was 62. 50%,without obvious adverse drug reactions and effects on heptorenal function. Conclusion Combined treatment of meropene,cefoperazone sulbactam and minocycline could produce good effects on the patients with ventilator-associated pneumonia caused by universal drug-resistant acinetobacter baumannii.