75例耐多药肺结核治疗副作用及转归分析

SIDE EFFECTS AND OUTCOMES ANALYSIS OF THE TREATMENT OF MULTI- DRUG RESISTANT TUBERCULOSIS: A CASE STUDY OF 75 PATIENTS

目的观察耐多药结核病药物的不良反应和治疗转归,以及不良反应对治疗转归的影响。方法对我所收治的2009~2011年列入全球基金耐多药项目的 75例患者,运用项目推荐的三种治疗方案,完成疗程后分析治疗副作用及转归情况。结果胃肠反应41例,肝功能损害21例,听力前庭损害11例,肾功能损害3例,关节肌肉痛12例,视力模糊2例,皮疹1例,血液系统改变、惊厥、外周神经损害、精神症状未见,可能与纳入例数较少有关。75例患者中治愈36例,完成治疗1例,失败21例,丢失2例,死亡2例,因严重不良反应停止治疗5例,其他8例。结论不良反应以胃肠反应和肝功能损害多见,对出现轻度药物不良反应可对症处理,严重不良反应及时停用可能的药物,使用敏感药物组成新方案。加强医防合作及流动人口管理,规律使用6个月注射剂,适当使用免疫增强剂及雾化排痰可提高依从性及治愈率。

Objective To observe the adverse reactions and treatment outcomes of multi- drug resistant TB drugs and the influence of adverse reactions on treatment outcomes. Methods 75 patients enlisted into the Global Fund for Multi- drug Resistant TB Drugs Items admitted in our hospital from 2009 to 2011 were selected and treated with three therapies recommended by the Fund separately. All treatments were finished and the outcomes were then analysed. Results 41 cases showed gastrointestinal reactions,21 liver function damages,11 listening and vestibular function damages,3renal dysfunction,12 arthralgia and courbature,2 blurred vision and 1 skin rash. No damages ofblood system change,convulsions,peripheral nerve injuries or psychiatric symptoms were observed,with the possibility of the small number of cases. Among 75 cases,36 were cured and 21 failed,1 was completely treated,2 were lost and 2 died. 5 were terminated due to severe adverse reactions,and 8 with other outcomes. Conclusion Among all adverse reactions,gastrointestinal reaction and liver function damage are most frequently observed. Slight adverse reactions could be treated symptomatically. Serious adverse reactions must be dealt with by withdrawing possible drugs and composed new scheme with sensitive drugs. Strengthening the cooperation between medical treatment and management of floating population,using injections for 6 months,using the immunoenhancer and atomization on sputum excretion appropriately can improve the compliance and the curative rate.