雾化吸入抗生素治疗呼吸机相关性肺炎的临床疗效观察

Efficacy of Nebulized Antibiotics in Treatment of Ventilator-associated Pneumonia

目的评价雾化吸入阿米卡星治疗呼吸机相关性肺炎(VAP)的临床疗效和安全性。方法选取2010年1月至2013年12月期间复旦大学附属上海市第五人民医院收治的VAP患者120例,随机分为两组:雾化治疗组(雾化组,60例)和常规治疗组(对照组,60例)。在相同常规治疗基础上,由经治医师根据相关指南决定患者全身抗生素的使用,雾化组在此基础上给予阿米卡星400 mg雾化吸入,对照组给予生理盐水5 m L雾化吸入,每日2次,观察两组患者的临床治愈率、细菌清除率、死亡率、脱机率及不良反应。结果研究第7 d,雾化组患者的临床治愈率大于对照组(75.0%比53.3%,P=0.013),细菌清除率大于对照组(75.0%比44.4%,P=0.008),但两组患者的粗死亡率、脱机率、不良反应比较,差异均无统计学意义。第28 d,雾化组患者的脱机率大于对照组(71.7%比51.7%,P=0.024),但死亡率差异均无统计学意义。结论雾化吸入阿米卡星治疗VAP,有助于提高患者的临床治愈率、细菌清除率和远期脱机率,无明显不良反应,但未能降低患者的死亡率。

Objective To evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia （VAP） caused by gram-negative bacilli. Methods From January 2010 to December 2013, a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group （60 patients） and a control group （60 patients） in Shanghai Fifth People＇ s Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians＇ decision according to guidelines, the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication, mortality, weaning rate and adverse events were recorded. Results At the end of nebulized treatment, the rate of clinical cure in the nebulized group was significantly higher than that in the control group （75.0% vs. 53.3% , P = 0. 013 ）. So was the rate of bacterial eradication （75.0% vs. 44.4% ,P=O. 008 ）. But the crude mortality and weaning rate were similar between two groups （P 〉 O. 05）. The adverse events in two groups were similar too （P 〉 0. 05）. When followed-up to the 28＇h day, the weaning rate in the nebulized group was significantly higher than that in the control group （71.7% vs. 51.7% ,P = 0. 024 ）, but the crude mortality was not different （ P 〉 0.05 ）. Conclusion Nebulized amikacin as an adjunctive therapy for the treatment of VAP, which do not demonstrate obviously adverse events, can help improve rate of clinical cure and bacterial eradication and long-term weaning rate, but can not reduce patients＇ crude mortality.