阿米卡星在治疗鲍曼不动杆菌呼吸机相关性肺炎的价值分析

Clinical value of amikacin in treatment of Acinetobacter baumannii ventilator associated pneumonia

目的对雾化吸入阿米卡星在治疗鲍曼不动杆菌呼吸机相关性肺炎的临床疗效和安全性进行观察。方法选取2013年6月至2014年12月我院收治的68例鲍曼不动杆菌呼吸机相关性肺炎患者,将其按照随机数字法随机分为观察组和对照组两组,每组34例,两组均给予全身抗感染治疗,观察组在全身感染治疗基础上给予阿米卡星注射液呼吸机雾化吸入,观察治疗8d后的两组临床肺部感染评分(CP IS)、支气管肺泡灌洗液培养结果转阴率,同时观察患者氧合指数(PaO2/FiO2)、肝肾功能等情况。结果观察组治愈率为73.5%,显著性高于对照组的47.1%(χ2=4.976,P<0.05);观察组支气管肺泡灌洗液培养转阴率为82.4%,显著性高于对照组的55.9%(χ2=5.581,P<0.05)。两组治疗后GPIS、PaO2/FiO2均较治疗前改善(t≥16.819 0,P<0.05),但观察组改善情况均优于对照组(t=3.187 2、6.262 1,P<0.05);治疗后观察组尿量较治疗前增加,对照组较治疗前下降,与治疗前相比差异均具有统计学意义(t=2.747 8、2.483 6,P<0.05);两组治疗后对照组尿量显著性低于观察组尿量相比,差异具有统计学意义(t=4.926 1,P<0.05);治疗后,观察组Cr与治疗前相比差异无统计学意义(t=1.567 4,P>0.05),对照组Cr较治疗前显著增加(t=9.703 3,P<0.05),治疗后对照组Cr显著性高于观察组Cr,差异具有统计学意义(t=8.845 2,P<0.05)。结论雾化吸入阿米卡星在治疗鲍曼不动杆菌呼吸机相关性肺炎临床效果好,安全性高,值得临床推广。

Objective To observe the clinical effect and safety of amikacin aerosol inhalation for the treatment of Acinetobacter baumannii ventilator associated pneumonia（VAP）.Methods 68 patients with Acinetobacter baumannii VAP from June 2013 to December 2014 in our hospital were selected and divided into the observation group or control group（34cases in each group）using random number method.All the patients were given systemic anti-infection treatment,while the observation group were additionally given atomization inhalation of amikacin.The clinical pulmonary infection score（CPIS）and the negative rate of bronchoalveolar lavage fluid culture results after treatment for 8days were observed;the oxygenation index（PaO2/FiO2）and liver and kidney function of the two groups were recorded and compared.Results The cure rate in the observation group was 73.5%,significantly higher than the 47.1%in the control group（χ2=4.976,P〈0.05）.The negative rate of bronchoalveolar lavage fluid culture in the observation group was 82.4%,significantly higher than the 55.9%in the control group（χ2=5.581,P〈0.05）.The GPIS and PaO2/FiO2 in both groups were improved after treatment（t≥16.819 0,all P〈0.05）,with the observation group superior to the control group（t=3.187 2and 6.2621,all P〈0.05）.The urine volume increased in the observation group while reduced in the control group after treatment,both with significant difference（t=2.747 8and2.483 6,P〈0.05）,and the urine volume in the control group was significantly lower than that in the observation group after treatment（t=4.926 1,P〈0.05）.The Cr in the observation group had no statistically significant difference after treatment（t=1.567 4,P1.567 4）,while that in the control group increased significantly than before treatment（t=9.703 3,P〈0.05）,and was significantly higher than that in the observation group（t=8.845 2,P〈0.05）.Conclusion Amikacin inhalation has good clinical effect and safety in treatment of Acinetobacter baumannii VAP.