CT引导下脓肿引流术对肺脓肿的疗效及细菌清除率的影响

Clinical Efficancy and Bacterial Clearance Rate Effect of CT Guided Abscess Drainage in Treatment of Pulmonary Abscess

目的探讨CT引导下脓肿引流术对肺脓肿的疗效及细菌清除率的影响。方法将2009年6月至2015年6月重庆市巴南区人民医院收治的78例肺脓肿患者按照随机数字表法分为观察组和对照组,各39例。对照组静脉滴注利奈唑胺,每8小时滴注1次,连续用药10~14 d;观察组在对照组基础上行CT引导下脓肿引流术。两组患者均治疗4周后进行疗效评价。比较两组患者咳嗽消失时间、体温恢复至正常时间、白细胞恢复至正常时间、脓腔完全吸收时间和细菌清除率,分别于治疗前、治疗第1、3、5、7日检测两组患者血清降钙素原（PCT）、白细胞介素6（IL-6）、C反应蛋白（CRP）水平。结果观察组总有效率显著高于对照组[87.2%（34/39）比66.7%（26/39）,P〈0.05]。观察组咳嗽消失时间、体温恢复时间、白细胞恢复时间、脓肿吸收时间、住院时间均显著短于对照组[（11.5±1.7）d比（14.3±2.2）d,（7.8±0.8）d比（9.7±1.1）d,（8.9±1.3）d比（14.7±2.5）d,（15.9±2.7）d比（20.7±3.1）d,（4.7±0.3）d比（7.6±0.5）d],差异有统计学意义（P〈0.01）。两组患者治疗后血清PCT,IL-6,CRP均呈下降趋势,且观察组下降速度更快,两组在组间、不同时点间、组间·不同时点间交互作用差异有统计学意义（P〈0.05）。两组患者病原菌清除率比较差异无统计学意义（P〉0.05）。结论 CT引导下脓肿引流术联合抗生素能显著提高肺脓肿的临床疗效、缩短治疗时间,炎性反应也得到有效控制,值得临床推广应用。

Objective To explore the clinical efficacy and bacterial clearance rate effect of CT guided abscess drainage in treatment of pulmonary abscess. Methods A total of 78 cases of pulmonary abscess treated in Banan District People’s Hospital from Jun. 2009 to Jun. 2015 were divided into observation group of 39 cases and control group of 39 cases according to random number table method： the control group was given intravenous infusion of linezolid 1 time every 8 h,continuous administration for 10 to 14 days; the observation group underwent CT guided abscess drainage based on the control group’s treatment. The clinical efficacy of the two groups were evaluated after 4 weeks. The cough disappearing time,body temperature returning to normal time,white blood cells returning to normal time,the total absorption of the abscess cavity and bacterial clearance rate of the two groups were compared,and the serum procalcitonin（ PCT）,interleukin-6（ IL-6）,C-reactive protein（ CRP） levels before and after 1,3,5,7 d of treatment were detected. Results The total effective rate in the observation group was significantly higher than that in the control group[87. 2%（ 34 /39）vs 66. 7%（ 26 /39）,P 〈 0. 05]. Compared with the control group,the observation group’ s cough time（ 11. 5 ± 1. 7） d,body temperature recovery time,white blood cell recovery time,abscess absorption time and hospitalization time was significantly shorter[（ 11. 5 ± 1. 7） d vs（ 14. 3 ± 2. 2） d,（ 7. 8 ± 0. 8） d vs（ 9. 7 ±1. 1） d,（ 8. 9 ± 1. 3） d vs（ 14. 7 ± 2. 5） d,（ 15. 9 ± 2. 7） d vs（ 20. 7 ± 3. 1） d,（ 4. 7 ± 0. 3） d vs（ 7. 6 ±0. 5） d],the differences were statistically significant（ P 〈 0. 05）. The serum levels of PCT,IL-6 and CRP were decreased in both groups after treatment,while the observation group decreased faster,there were significant difference between the two groups,different time points and the interaction of the groups· different time points（ P 〈 0. 05）. The bacterial clearance rate in the two groupshad no statistically significant difference（ P 〉 0. 05）. Conclusion CT guided abscess drainage combined with antibiotics can significantly improve the clinical curative effect,shorten the treatment time,and relieve the inflammatory reaction,thus is worthy of clinical promotion.