美罗培南联合不同剂型头孢哌酮-舒巴坦治疗泛耐药鲍氏不动杆菌致呼吸机相关性肺炎临床疗效及安全性分析

Clinical Efficacy and Safety of Meropenem Combined with Different Doses of Cefperazone-Sulbactam in Treatment of Ventilator Associated Pneumonia Induced by Pan-Resistant Acinetobacter Baumannii

目的观察分析美罗培南联合不同剂型头孢哌酮-舒巴坦治疗泛耐药鲍氏不动杆菌(PDR-AB)致呼吸机相关性肺炎(VAP)临床疗效及安全性。方法选取2013年6月—2016年3月收治的46例PDR-AB所致VAP患者作为研究对象,根据头孢哌酮-舒巴坦剂型不同分为A组27例和B组19例,A组使用美罗培南联合头孢哌酮-舒巴坦1∶1剂型进行治疗,B组使用美罗培南联合头孢哌酮-舒巴坦2∶1剂型进行治疗。回顾性分析所选患者的临床资料,观察分析两组的临床疗效、细菌学疗效、相关实验室指标及不良反应情况。结果 A组临床有效率低于B组(P<0.05)。两组细菌清除有效率比较差异无统计学意义(P>0.05)。治疗后,两组血红细胞计数、白细胞计数、丙氨酸转氨酶、肌酐、C反应蛋白和降钙素原水平均低于治疗前(P<0.05),且A组高于B组(P<0.05)。A组总不良反应发生率低于B组(P<0.05)。结论美罗培南联合头孢哌酮-舒巴坦2∶1剂型治疗PDR-AB所致VAP临床疗效更佳,但不良反应发生率较高。

Objective To observe clinical efficacy and safety of Meropenem combined with different dosages of Cefoperazone-Sulbactam in treatment of ventilator associated pneumonia （VAP） induced by pan-resistant acinetobaeter baumannii. Methods A total of 46 patients with VAP induced by pan-resistant acinetobacter baumannii admitted during June 2013 and March 2016 were divided into group A （n=27） and group B （n=19） according to Cefoperazone-Sulbac- tam dosage. Group A was given Meropenem combined with Cefoperazone-Sulbaetam by 1： 1 formulation, while group B was given Meropenem combined with Cefoperazone-Sulbactam by 2： 1 formulation. Clinical data of the selected patients was retrospectively analyzed. Clinical efficacy, bacteriological efficacy, related laboratory indexes and adverse reactions were observed and analyzed in two groups. Results Clinical effective rate was significantly lower in group A than that in group B （ P 〈 0. 05 ）. There was no significant difference in bacterial clearance between the two groups （ P 〉 0. 05 ）. Af- ter treatment, levels of blood red blood cell count, white blood cell count, alanine transarninase, creatinine, C reactive protein and ealcitonin were significantly lower than those before treatment in two groups （ P 〈 0. 05 ） , and the levels in group A were significantly higher than those in group B （P 〈 0. 05 ）. The total incidence rate of adverse reactions in group A was significantly lower than that in group B （P 〈 0. 05 ）. Conclusion Meropenem combined with Cefoperazone-Sul- baetam by 2： 1 formulation has better efficacy in treatment of VAP induced by pan-resistant acinetobacter baumannii, but it has higher incidence rate of adverse reactions.