多粘菌素联合舒巴坦治疗鲍曼不动杆菌感染性呼吸机相关肺炎的疗效观察

Observation on effect of polymixin combined with sulbactam in treatment of baumanii infected ventilator associated pneumonia

目的探讨多粘菌素联合舒巴坦治疗鲍曼不动杆菌感染性呼吸机相关肺炎(VAP)的疗效。方法选取2013年1月至2014年6月该院住院诊断为鲍曼不动杆菌感染的VAP患者54例,随机分为对照组和多粘菌素联合舒巴坦治疗组各27例。通过给药后第4天的抗生素反应性评价分析,以及给药后第14天的临床疗效评价。动态观察用药后第4天和第14天的降钙素原(PCT)水平变化。综合分析多粘菌素联合舒巴坦治疗鲍曼不动杆菌感染性VAP的疗效。结果治疗后第4天,对照组有效率(33.3%)低于观察组有效率(40.7%),但差异无统计学意义(P>0.05)。第14天,对照组在治疗成功率,致病菌清除率以及重症监护室(ICU)平均住院日方面均低于观察组,但除致病菌清除率外,其他差异均无统计学意义(P>0.05)。多粘菌素的肾毒性评价方面,共有12例患者出现了肾功能损伤表现,通过RIFLE评分可见危险期4例(33.3%),损伤期6例(50.0%),肾功能衰竭期2例(16.7%)。肝毒性反面,对照组5例(18.5%)患者用药后出现了肝酶的升高,而观察组为2例(7.4%)。在用药后第4天和第14天观察组PCT水平均小于对照组,差异有统计学意义(P<0.05)。结论观察组的有效率、治疗成功率以及ICU平均住院日方面均优于对照组,差异有统计学意义(P<0.05)。

Objective To investigation the effect of polymixin combined with sulbactam in the treatment of baumanii infected ventilator associated pneumonia（VAP）. Methods 54 patients with baumanii infected VAP in our hospital from January 2013 to June 2014 were selected and randomly divided into the polymixin combined sulbaetam treatment group（observation group, n = 27） and the control group（n = 27）. The microbiological responses to therapy were assessed on 4 d and the clinical effect was evaluated on 14 d of therapy. The change of procalcitonin（PCT） on 4, 14 d of medication was dynamically observed. The effects of polymixin combined with sulbactam in treating baumanii infected VAP was comprehensively analyzed. Results The effective rate on 4 d of treatment in the control group was 33.3 %, which was lower than 40.7 % in the observation group, but the difference had no statistical significance（P〉0.05）. The treatment success rate,pathogenic bacterial clearance rate and average ICU stay on 14 d of treatment in the control group were lower than those in the observation group, but except for pathogenic bacterial clearance rate, the other differences had no statistical significance （P〉0.05）. In the aspect of the renal toxicity evaluation, 12 cases appeared the renal function injury manifestation, there were 4 cases（33.3% ） of risk stage, 6 cases（50.0 % ） of injury stage, and 2 cases （ 16.7% ） of renal failure by the RIFLE score, in the hepatic toxicity, 5 cases（ 18.5 % ） in the control group appeared the liver enzyme increase, while the observation group had 2 cases（7.4 %）. The PCT level on 4,14 d of medication in the observation group was lower than that in the control group with statistical difference （P〈0. 05）. Conclusion The effective rate,treatment success rate and average ICU stay in the observation group was su- perior to the control group with Statistical difference（P〈0.05）.