ICU患者泛耐药鲍氏不动杆菌肺部感染治疗效果分析

Therapeutic effect of ICU patients with pandrug-resistant Acinetobacter baumannii pulmonary infection

目的探讨头孢哌酮/舒巴坦、头孢哌酮/舒巴坦联合阿米卡星、替加环素对重症监护病房(ICU)泛耐药鲍氏不动杆菌(PDRAB)肺部感染治疗效果。方法回顾性分析2012年3月-2014年1月医院ICU收治的PDRAB肺部感染患者65例,其中A组23例患者应用头孢哌酮/舒巴坦治疗、B组24例患者应用头孢哌酮/舒巴坦联合阿米卡星治疗、C组18例患者应用替加环素治疗,3组均治疗14d;监测3组治疗前后患者白细胞计数(WBC)、C-反应蛋白(CRP)和降钙素原(PCT)变化,记录并比较各组患者临床疗效、脱机成功率及30d病死率。结果 A、B、C组治疗前WBC、CRP、PCT比较差异均无统计学意义,治疗后各指标均较治疗前呈降低趋势(P<0.05),且以C组PCT降低更显著,C组患者治疗总有效率88.89%、脱机成功率56.25%,均高于A组82.61%、41.74%和B组的83.33%、43.55%,差异有统计学意义(P<0.05);C组患者30d病死率22.56%,明显低于较A、B组的36.85%、35.20%(χ2=12.43,P=0.040)。结论替加环素可以提高ICU内肺部感染PDRAB患者脱机成功率和生存率,降低病死率,有较好的临床疗效。

OBJECTIVE To explore the curative effects of cefoperazone-sulbactam,cefoperazone-sulbactam combined with amikacin,and tigecycline on treatment of pandrug-resistant Acinetobacter baumannii pulmonary infection in intensive care unit（ICU）.METHODS A total of 65 patients with pandrug-resistant A.baumannii pulmonary infection who were treated in the hospital from Mar 2012 to Jan 2014 were enrolled in the study,the group A with23 cases was treated with cefoperazone-sulbactam,the group B with 24 cases was treated with cefoperazone-sulbactam combined with amikacin,and the group C with 18 cases was treated with tigecycline;all the three groups were treated for 14 days.The white blood cell（WBC）counts and the levels of C-reactive protein（CRP）and procalcitonin（PCT）of the three groups were monitored before and after the treatment,and the clinical efficacy,rate of successful weaning of mechanical instrument,and 30-day mortality rate were observed and compared among the three groups of patients.RESULTS There was no significant difference in the WBC counts,the level of CRP or PCT among the group A,B,and C before the treatment;the levels of the indicators showed downward trends after the treatment（P0.05）,and the level of PCT was reduced more significantly in the group C.The total effective rate of treatment of the group C was 88.89%,higher than 82.61% of the group A and 83.33% of the group B;the rate of successful weaning of mechanical instrument of the group C was 56.25%,higher than 41.74% of the group A and 43.55% of the group B,and there was significant difference（P0.05）.The 30-day mortality rate of the group C was 22.56%,significantly lower than 36.85% of the group A and 35.20% of the group B（χ2=12.43,P=0.040）.CONCLUSIONTigecycline can raise the rate of successful weaning of mechanical instrument and the survival rate and reduce the mortality rate,with the clinical efficacy good.