多重耐药鲍曼不动杆菌重症肺炎的药物治疗体会

Experience of drug treatment of multiple drug resistant acinetobacter bauman in severe pneumonia

目的研究不同的药物对多重耐药鲍曼不动杆菌引起的重症肺炎的临床治疗效果,为今后的临床应用提供参考。方法采用回顾性分析的方法,对余姚市第二人民医院重症医学科在2011年6月~2016年6月期间收治的多重耐药鲍曼不动杆菌重症肺炎患者250例进行研究。按随机数字表法分为观察组和对照组,每组125例。观察组采用泰能（亚胺培南/西司他汀钠）、美平（美罗培南）、舒普深（头孢哌酮舒巴坦钠）、左氧氟沙星多药联合的方式进行治疗,对照组单独给予多粘菌素E进行治疗。比较2组患者的临床疗效、不良反应发生率、C-反应蛋白（CRP）、白细胞计数（WBC）。结果观察组治疗后临床总有效率为87.20%,对照组治疗后总有效率为61.60%,组间比较差异具有统计学意义（P〈0.05）。观察组不良反应发生率10.40%,对照组为8.80%,组间比较无显著性差异。在炎症指标比较中,观察组的CRP、WBC均显著低于对照组（P〈0.05）。结论泰能、美平、舒普深、左氧氟沙星多药联合治疗多重耐药鲍曼不动杆菌重症肺炎,临床疗效好,不良反应少,是一个值得在临床上推广使用的多药联合的药物治疗方案。

Objective To study the effect of different drugs on the treatment of severe pneumonia caused by multi drug resistant Acinetobacter Bauman, and to provide reference for clinical application in the future.MethodsA retrospective analysis was conducted on 250 cases of severe pneumonia patients with multiple drug resistant Acinetobacter Bauman admitted to intensive care unit in Yuyao Second People＇s Hospital from June 2011 to June 2016.The 250 cases were divided into the observation group and the control group, 125 cases in each group.The observation group were given imipenem （imipenem/cilastatin sodium）, mepem （meropenem）, sulperazone （Chuba Staw Na, cefoperazone） and levofloxacin, while the control group were given polymyxin E.The clinical efficacy, adverse reaction rate, C-reactive protein（CRP） and white blood cell count（WBC） were compared between the two groups.ResultsAfter treatment, the total effective rate in the observation group was 87.20% and 61.60% in the control group, the difference between the two groups was statistically significant, P〈0.05.The adverse reaction rate in the observation group was 10.40% and 8.80% in the control group.There was no significant difference between the two groups about adverse reaction rarte.Inflammatory markers, CRP and WBC in the observation group were significantly lower than those in the control group, P〈0.05.ConclusionImipenem, mepem, sulperazone and levofloxacin in treatment of severe pneumonia with multi drug resistant Acinetobacter Bauman, the clinical curative effect is good, less adverse reaction, is a drug treatment program that is worth promoting in clinical practice.