大蒜素治疗细菌感染所致呼吸机相关性肺炎的临床研究

Clinical Study of Allicin on Treatment of Ventilator-Associated Pneumonia Caused by Bacterial Infection

目的评估大蒜素治疗细菌感染所致呼吸机相关性肺炎危重患者的临床疗效。方法采用前瞻性随机对照研究方法,选取2011年01月-2014年12月收入重症监护病房且符合呼吸机相关性肺炎诊断标准的92例患者(均为细菌感染所致),按照随机数字表法将其分为治疗组42例及对照组50例。对照组在常规治疗基础上加用抗生素治疗,治疗组在对照组基础上加用大蒜素治疗,疗程14 d。分析两组患者的病原菌分布情况,比较两组患者机械通气时间、抗生素治疗时间、住ICU时间及14 d病死率;并观察记录大蒜素使用过程中安全性及不良反应发生率。结果细菌感染所致呼吸机相关性肺炎患者的常见病原菌为鲍曼不动杆菌(35.2%)、金黄色葡萄球菌(17.1%)、铜绿假单胞菌(13.3%)、肺炎链球菌(13.3%)及肺炎克雷伯菌(8.6%)。治疗组机械通气时间略短于对照组(P>0.05),抗生素使用时间及住ICU时间显著短于对照组(P<0.01)。两组患者治疗后14 d病死率无统计学差异(P>0.05)。结论细菌感染所致呼吸机相关性肺炎患者在常规抗感染治疗基础上加用大蒜素治疗,能显著缩短抗生素使用时间,且有缩短患者机械通气时间及住ICU时间,临床不良反应发生率低,可以安全使用。

Objective To explore the clinical effect of allicin on treatment of ventilator-associated pneumonia caused by bacterial infection. Methods A prospective randomized control study was conducted. Totally 92 patients treated in ICU from Jan 1 2011 to Dec 2014 with bacterial infection ventilator associated pneumonia were enrolled in the study and randomly divided into two groups, with 42 cases in the treatment group and 50 cases in the control group. The control group was treated with antibiotics on the basis of conventional therapy, the treatment group was given allicin injection for 14 days on the basis of the treatment of the control group. Distribution of pathogenic bacteria in the two groups of patients were analyzed. Length of mechanical ventilation, the therapeutic days of using antibiotics, days of stay in ICU and 14-day mortality were compared between the two groups. Safety and drug-induced adverse reactions of all the patients were monitored during treatment. Results The Acinetobacter baumannii（35.2%）, Staphylococcus aureus（17.1%）, Pseudomonas aeruginosa（13.3%）Streptococcus pneumoniae（13.3%） and Klebsiella pneumonia（8.6%） were the most common pathogens in VAP patients caused by bacterial infection. The mechanical ventilation time in the treatment group was slightly shorter than that in the control group（P〈0.05）. The antibiotics using time and ICU staying time was significantly shoter than that in the control group（P〈0.01）. The fatality rate between two groups had no statistical significant after 14 days treatment（P〈0.05）. Conclusion Allicin combined with basic treatment in VAP patients caused by bacterial infection significantly shortened therapeutic days of using antibiotics, mechanical ventilation and days of stay in ICU. It could be safely used in clinic, and with low incidence of adverse reactions.