不同剂量替加环素治疗泛耐药鲍曼不动杆菌重症肺炎临床分析

The Clinical Analysis of Different Doses of Tigecycline in the Treatment of Severe Pneumonia Caused by Extensively-drug Resistant Acinetobacter Baumannii

目的探讨不同剂量替加环素治疗泛耐药鲍曼不动杆菌重症肺炎的临床效果。方法选取2015年8月—2017年7月住我院重症监护室内泛耐药鲍曼不动杆菌重症肺炎患者52例,按照随机数字表法分为常规剂量组及增加剂量组,组内各包含26例,常规剂量组给予替加环素100 mg(首剂),之后50 mg,每12 h一次,增加剂量组给予替加环素100 mg,每12 h一次,两组均联合头孢哌酮舒巴坦3 g,每8 h一次,结果增加剂量组临床总有效率(76.9%)高于常规剂量组总有效率(46.2%),两组差异有统计学意义(P<0.05),增加剂量组细菌清除率(65.4%)高于常规剂量组细菌清除率(34.6%),两组差异有统计学意义(P<0.05),增加剂量组治疗后白细胞计数、降钙素原、C反应蛋白均低于常规剂量组治疗后,两组差异有统计学意义(P<0.05),不良反应两组差异无统计学意义(P>0.05)。结论对于泛耐药鲍曼不动杆菌重症肺炎增加替加环素剂量可以提高疗效。

Objective To investigate clinical efficacy of use of different doses of tigecycline in the treatment of severe pneumonia caused by extensively- drug resistant Acinetobacter baumannii. Methods A total of 52 patients with severe pneumonia caused by extensively-drug resistant Acinetobacter baumannii from ICU of our hospital were included from August 2015 to July 2017. The patients were randomly assigned to conventional-dose group （26 cases）, or high-dose group（26 cases）. Conventional-dose group was given tigecycline with initial dose of 100 mg, and then 50 mg every 12 hours. High-dose group was given tigecycline with dose of 100 mg every 12 hours. Both regimens were combined with Cefoperazone- Sulbactam （3 g, every 8 hours）. Results The response rate of high-dose group were significantly higher than conventional-dose group （76.9% vs.46.2%） （P 〈 0.05）. The bacterial clearance rate of high-dose group were also significantly higher than conventional-dose group （65.4% vs. 34.6%） （P 〈 0.05）. The post-treatment white blood count, PCT, CRP of high-dose group were significantly lower than that of conventional- dose group （P 〈 0,05）. There was no significantly difference between two groups in the incidence of adverse drug reaction （P 〉 0.05 ）. Conclusion For severe pneumonia caused by extensively-drug resistant Acinetobacterbaumannii, high-dose tigecyeline can significantly improve therapeutic efficacy.