替加环素联合异帕米星治疗多重耐药鲍曼不动杆菌肺炎的临床观察

Clinical Observation of Tigecycline Combined with Isepamicin in the Treatment of Multidrug-resistant Acinetobacter baumannii Pneumonia

目的:观察替加环素联合异帕米星治疗多重耐药鲍曼不动杆菌肺炎的临床疗效及安全性。方法:选取被诊断为多重耐药鲍曼不动杆菌肺炎的患者70例,按随机数字表法分为对照组和观察组,各35例。两组患者均给予氧疗或机械通气、降压、控制血糖等常规治疗。对照组患者给予注射用头孢哌酮钠舒巴坦钠3 g加入氯化钠注射液100 ml中,ivgtt,qid;观察组患者给予注射用替加环素首次剂量100 mg,然后减至50 mg加入氯化钠注射液250 ml中,ivgtt,bid,联合硫酸异帕米星注射液400 mg加入氯化钠注射液250 ml中,ivgtt,qd。观察两组患者体温恢复正常、肺部啰音消失、胸片阴影消失、白细胞恢复正常时间及治疗前后血清炎性因子水平,并比较两组患者临床疗效、细菌学疗效及不良反应发生情况。结果:观察组患者体温恢复正常、肺部啰音消失、胸片阴影消失、白细胞恢复正常时间明显短于对照组,差异有统计学意义(P<0.05)。治疗前,两组患者血清炎性因子水平比较,差异无统计学意义(P>0.05);治疗后,两组患者血清炎性因子水平显著降低,且观察组明显低于对照组,差异均有统计学意义(P<0.05)。观察组患者临床总有效率和有效细菌清除率(85.7%和82.9%)显著高于对照组(62.9%和60.0%),差异均有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:替加环素联合异帕米星治疗多重耐药鲍曼不动杆菌肺炎疗效显著,能明显改善患者临床症状,控制炎症反应,杀菌作用明显,且安全性较高。

OBJECTIVE： To observe clinical efficacy and safety of tigecycline combined with isepamicin in the treatment of multidrug-resistant Acinetobacter baumannii pneumonia. METHODS： 70 patients diagnosed as multidrug-resistant A. baumannii pneumonia were selected and randomly divided into control group and observation group, with 35 cases in each group. Both groups received routine treatment oxygen therapy or mechanical ventilation, anti-hypertension, hypoglycemic therapy. Control group was given Cefoperazone sulbactam for injection 3 g added into Sodium chloride injection 100 ml, ivgtt, qid. Observation group received Tigecycline for injection 100 mg, decreasing to 50 mg added into Sodium chloride injection 250 ml, ivgtt, bid, combined with Isepamicin sulfate injection 400 mg added into Sodium chloride injection 250 ml, ivgtt, qd. The time of body temperature return to normal, pulmonary rale disappearance, chest X-ray shadow disappearance and leucocyte return to normal were observed in 2 groups as well as serum inflammatory factor level before and after treatment; total effective rate, bacterial clearance rate and ADR were compared between 2 groups. RESULTS： The time of body temperature return to normal, pulmonary rale disappearance, chest X-ray shadow disappearance and leucocyte return to normal in observation group were significantly shorter than in control group, with statistical significance （P〈0.05）. There was no statistical significance in serum inflammatory factor between 2 groups before treatment （P〉0.05）. The serum inflammatory factor of 2 groups decreased significantly after treatment, and the observation group was significantly lower than the control group, with statistical significance （P〈0.05）. Total effective rate and effective bacterial clearance rate of observation group were 85.7% and 82.9% , which were significantly higher than those of control group （62.9% and 60.0% ）, with statistical significance （P〈0.05）. There was no statistical significance in the incidence of ADR between 2 groups （P〉0.05）. CONCLUSIONS： Tigecycline combined with isepamicin is effective for multidrug-resistant A. baumannii pneumonia, and can improve clinical symptom, control inflammation reaction, having high sterilization with good safety.