利奈唑胺对比万古霉素治疗老年呼吸机相关肺炎的临床研究

Clinical study on linezolid and vancomycin in the treatment of ventilator associated pneumonia in elderly patients

目的评价利奈唑胺与万古霉素治疗老年呼吸机相关性肺炎(VAP)的疗效及安全性。方法入选76例耐甲氧西林金黄色葡萄球菌(MRSA)老年VAP患者,随机分为万古霉素组37例(对照组)与利奈唑胺组39例(试验组)。对照组静脉滴注万古霉素1.0 g,每日2次,共7 d;试验组静脉滴注利奈唑胺600 mg,每日2次,共7 d。比较2组临床疗效,病原菌清除率,治疗疗程,治疗前后相关炎症指标水平变化情况及不良反应发生率。结果治疗后,对照组临床总有效率为78.38%,显著低于试验组的94.87%(P<0.05)。对照组病原菌清除率为59.46%,显著低于试验组的87.18%(P<0.05)。对照组治疗疗程为(17.27±3.33)d,显著高于试验组的(13.02±3.07)d(P<0.05)。2组治疗后白细胞、C反应蛋白及降钙素原水平变化均显著低于治疗前,且试验组治疗后上述指标显著高于对照组(P<0.05)。对照组不良反应发生率为10.81%,试验组为10.26%,差异无统计学意义(P>0.05)。结论利奈唑胺治疗MRSA老年VAP的疗效显著优于万古霉素,不良反应发生率无差异。

Objective To investigate the efficacy and safety of linezolid and vancomycin in the treatment of ventilator associated pneumonia in elderly patients. Methods A total of 76 patients with methicillin -resistant Staphylococcus aureus （MRSA） related ventilator associated pneumonia were recruited in our hospital. The 76 patients were randomly divided into control group （ n = 37 ） and trial group （ n = 39 ）. Patients in the control group were given vancomycin 1.0 g bid by intravenous drop infusion for 7 days and patients in the treatment group were given linezolid 600 mg bid by intravenous drop infusion for 7 days. After treatment, the data of clinical efficacy, pathogen clearance, treatment course, inflammatory factors and adverse reactions were compared between the two groups. Results The clinical efficacy of trial group was statistically higher than that of control group （94.87% vs 78.38%, P 〈0. 05）. The pathogen clearance of trial group was statistically higher than that of control group（ 87. 18% vs 59. 46%, P 〈0. 05）. The treatment course of trial group was statistically shorter than that of control group [ （13.02 ±3.07） vs （717.27 ±3.33）d, P 〈0.05） ]. The inflammatory factors （WBC, PLT, CRP and PCT）were significantly decreased after treatment in both groups （ P 〈 0. 05 ）. The incidence rate of adverse reactions in the two groups were not statistically different （ P 〉 0. 05 ）. Conclusion Linezolid is superior to vancomycin in the treatment of ventilator associated pneumonia in elderly patients, without significant difference in adverse reactions.